Provider Demographics
NPI:1306988332
Name:DENICCO, AUGUST ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:AUGUST
Middle Name:ANDREW
Last Name:DENICCO
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 1:554 E HIGH ST
Mailing Address - Street 2:
Mailing Address - City:POTTSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19464-5690
Mailing Address - Country:US
Mailing Address - Phone:610-326-9312
Mailing Address - Fax:610-326-9178
Practice Address - Street 1:554 E HIGH ST
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-5690
Practice Address - Country:US
Practice Address - Phone:610-326-9312
Practice Address - Fax:610-326-9178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017407L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice