Individual
DR. NICHOLAS JOHN CIVILLICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
626 BURMOND RD., DREXEL HILL, PA 19026
(610) 352-6560
(484) 466-3132
Mailing address
626 BURMOND RD., DREXEL HILL, PA 19026
(610) 352-6560
(484) 466-3132
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS019365L
PA
Other
Enumeration date
06/22/2008
Last updated
09/26/2018
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