Provider Demographics
NPI:1962516252
Name:CICCONE, CARL GEORGE (DDS)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:GEORGE
Last Name:CICCONE
Suffix:
Gender:F
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:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:NH
Mailing Address - Zip Code:03561-0375
Mailing Address - Country:US
Mailing Address - Phone:603-444-6411
Mailing Address - Fax:603-444-1629
Practice Address - Street 1:175 COTTAGE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:NH
Practice Address - Zip Code:03561-4201
Practice Address - Country:US
Practice Address - Phone:603-444-6411
Practice Address - Fax:603-444-1629
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH13671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA157698OtherUNITED CONCORDIA
NH191844Medicaid
VA236429OtherANTHEM BCBS