Active NPI
Lucas Jordan Diciccio, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Fresno, CA
National Provider Identifier
1134835598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 105009
- Practice address
- 7055 N Fresno St Ste 302
Fresno, CA 93720-2957 - Phone
- (559) 325-3300
- NPI assigned
- Jan 27, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 105009 | CA | Primary |
Addresses
Primary practice location
7055 N Fresno St Ste 302
Fresno, CA 93720-2957
Mailing address
11378 N Via Montessori Dr
Fresno, CA 93730-8839
Phone (559) 451-1873
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 105009 | CA | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1134835598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11378 N VIA MONTESSORI DR",
"city": "FRESNO",
"state": "CA",
"postal_code": "937308839",
"telephone_number": "559-451-1873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7055 N FRESNO ST STE 302",
"city": "FRESNO",
"state": "CA",
"postal_code": "937202957",
"telephone_number": "559-325-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICICCIO",
"first_name": "LUCAS",
"middle_name": "JORDAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-01-27",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "105009",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fresno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.