Provider Demographics
NPI:1306932546
Name:CICORELLI, CONNIE F (DDS)
Entity type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:F
Last Name:CICORELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CONNIE
Other - Middle Name:F
Other - Last Name:CICORELLI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1401 SILVERSIDE RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4400
Mailing Address - Country:US
Mailing Address - Phone:302-798-5797
Mailing Address - Fax:302-798-9232
Practice Address - Street 1:1401 SILVERSIDE RD CICORELLI DENTAL GROUP
Practice Address - Street 2:SUITE 2A
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4400
Practice Address - Country:US
Practice Address - Phone:302-798-5797
Practice Address - Fax:302-798-9232
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00009581223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE200110331Medicaid