Organization
CIVILLICO FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NICHOLAS J. CIVILLICO D.D.S. (OWNER/PRACTITIONER)
(610) 352-6560
Entity
Organization
Contact information
Practice address
626 BURMONT RD, DREXEL HILL, PA 19026-3827
(610) 352-6560
(484) 466-3132
Mailing address
626 BURMONT RD, DREXEL HILL, PA 19026-3827
(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
12/14/2016
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