Civillico Family Dentistry

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS019365L Issued in PA

Legal business name

CIVILLICO FAMILY DENTISTRY

Practice address

626 Burmont Rd
Drexel Hill, PA 19026-3827

Phone

(610) 352-6560

Fax

(484) 466-3132

NPI assigned

Jun 22, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nicholas J. Civillico, D.D.S.NPI 1073774048

Title

Owner/Practitioner

Phone

(610) 352-6560

Specialties & licenses 1

Addresses

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nicholas John Civillico, DDS

  • General Practice Dentistry
  • Drexel Hill, PA
  • NPI 1073774048
  NPD (past) Authorized official
• John N Civillico, DMD

  • Dentist
  • Drexel Hill, PA
  • NPI 1861668360
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481673600000",
    "number": "1417118480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "626 BURMONT RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190263827",
            "telephone_number": "610-352-6560",
            "fax_number": "484-466-3132"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "626 BURMONT RD",
            "city": "DREXEL HILL",
            "state": "PA",
            "postal_code": "190263827",
            "telephone_number": "610-352-6560",
            "fax_number": "484-466-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CIVILLICO FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-22",
        "last_updated": "2016-12-14",
        "status": "A",
        "authorized_official_last_name": "CIVILLICO",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "OWNER/PRACTITIONER",
        "authorized_official_telephone_number": "610-352-6560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS019365L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chef Wellness Clinic
• Yun-Lin Cheng, M.D.
• Children'S Hospital of Philadelphia (CHOP Primary Care Drexel Hill)
• Chiropractic Wellness and Rehabilitation Clinic LLC
• Choice Empowers Services LLC
• John N Civillico, DMD
• Nicholas John Civillico, DDS
• Richard James Clark III, DDS
• Clinical Alternative Specialists
• Clover Dental

• General Practice Dentistry in Drexel Hill, PA
• Providers in Drexel Hill, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.