Provider Demographics
NPI:1588901169
Name:SECCHI, ANTONINO GESUINO (DMD, MS)
Entity type:Individual
Prefix:
First Name:ANTONINO
Middle Name:GESUINO
Last Name:SECCHI
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:229 W LANCASTER AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:DEVON
Mailing Address - State:PA
Mailing Address - Zip Code:19333-1589
Mailing Address - Country:US
Mailing Address - Phone:484-580-8050
Mailing Address - Fax:484-580-8474
Practice Address - Street 1:229 W LANCASTER AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1589
Practice Address - Country:US
Practice Address - Phone:484-580-8050
Practice Address - Fax:484-580-8474
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-15
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics