Richard C Squillaro D.D.S., PC

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS017459L Issued in PA

Legal business name

RICHARD C SQUILLARO D.D.S., PC

Practice address

2546 S Broad St
Philadelphia, PA 19145-4638

Phone

(215) 463-6677

Fax

(215) 463-1077

NPI assigned

Apr 11, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard Carmen Squillaro, D.D.S.

Title

President

Phone

(215) 463-6677

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368489600000",
    "number": "1932323235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1512 TEMPLE DR",
            "city": "MAPLE GLEN",
            "state": "PA",
            "postal_code": "190023312",
            "telephone_number": "215-628-8627",
            "fax_number": "215-628-8937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2546 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454638",
            "telephone_number": "215-463-6677",
            "fax_number": "215-463-1077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD C SQUILLARO D.D.S., PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-11",
        "last_updated": "2013-05-14",
        "status": "A",
        "authorized_official_last_name": "SQUILLARO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "CARMEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "215-463-6677",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS017459L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Periodontics in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Periodontics in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2013; 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.