John Facciolo, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

G1-0011491 Issued in DE

Practice address

1304 N Broom St
Wilmington, DE 19806-4266

Phone

(302) 652-2451

NPI assigned

Mar 24, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DE

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• John M Facciolo D.M.D., P.a.

  • General Practice Dentistry
  • Wilmington, DE
  • NPI 1326825282
  NPD Authorized official

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

{
    "created_epoch": "1585008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1922635606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 THORNDALE DR",
            "city": "HOCKESSIN",
            "state": "DE",
            "postal_code": "197072332",
            "telephone_number": "302-584-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1304 N BROOM ST",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198064266",
            "telephone_number": "302-652-2451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACCIOLO",
        "first_name": "JOHN",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-24",
        "last_updated": "2024-05-08",
        "certification_date": "2021-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "DE",
            "license": "G1-0011491",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eye Consultants LLC
• Eye Physicians & Surgeons, PA
• Eyewear Boutique
• Paige Ezell
• Facciolo Orthodontics, LLC
• Joseph Thomas Facciolo, D.M.D.
• Raymond Facciolo Jr., DPT
• Heather C Fackelman
• William Fader, FNP
• Lynn M Fahey

• General Practice Dentistry in Wilmington, DE
• Providers in Wilmington, DE by specialty
• General Practice Dentistry in Delaware

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.