Individual
MS. LORETTA A CICCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12 BENNINGTON ST, FLOOR 2, EAST BOSTON, MA 02128
(617) 561-7600
Mailing address
12 BENNINGTON ST, FLOOR 2, EAST BOSTON, MA 02128
(617) 561-7600
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9777881
MASS HEALTH
—
Enumeration date
11/19/2007
Last updated
11/19/2007
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