Active NPI
John N Civillico, DMD
- Dentist
- Drexel Hill, PA
National Provider Identifier
1861668360
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS037196
- Practice address
- 626 Burmont Rd
Drexel Hill, PA 19026-3827 - Phone
- (610) 352-6560
- Fax
- (484) 466-3132
- NPI assigned
- May 5, 2008
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DS037196 | PA | Primary |
Addresses
Primary practice location
626 Burmont Rd
Drexel Hill, PA 19026-3827
Mailing address
626 Burmont Rd
Drexel Hill, PA 19026-3827
Phone (610) 352-6560
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102132422 | Medicaid | PA |
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 |
|---|---|---|---|
| DS037196 | PA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Civillico Family Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Drexel Hill, PA
- NPI 1417118480
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538006400000",
"number": "1861668360",
"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": {
"last_name": "CIVILLICO",
"first_name": "JOHN",
"middle_name": "N",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-05-05",
"last_updated": "2018-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS037196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102132422",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Drexel Hill, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.