Provider Demographics
NPI:1396762308
Name:ILACQUA, JOSEPH A (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:A
Last Name:ILACQUA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 DEKALB PIKE
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401
Mailing Address - Country:US
Mailing Address - Phone:610-275-0500
Mailing Address - Fax:610-275-1054
Practice Address - Street 1:2603 DEKALB PIKE
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401
Practice Address - Country:US
Practice Address - Phone:610-275-0500
Practice Address - Fax:610-275-1054
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022706L204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T71912Medicare UPIN
094462Medicare ID - Type Unspecified