Individual
DR. JOHN N CIVILLICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
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
122300000X
Dentist
Primary
DS037196
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102132422
—
PA
Enumeration date
05/05/2008
Last updated
09/27/2018
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