Provider Demographics
NPI:1427118892
Name:JOSEPH A CICCIO JR DDS AND PETER B DEMAREST DMD PLLC
Entity type:Organization
Organization Name:JOSEPH A CICCIO JR DDS AND PETER B DEMAREST DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CICCIO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-337-4700
Mailing Address - Street 1:1 PONDFIELD ROAD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708
Mailing Address - Country:US
Mailing Address - Phone:914-337-4700
Mailing Address - Fax:914-395-1460
Practice Address - Street 1:117 E 77TH ST APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1823
Practice Address - Country:US
Practice Address - Phone:212-535-0515
Practice Address - Fax:212-717-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY03762421223X0400X
NY04572621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty