Diecidue, Robert J

Diecidue, Robert J is an individual health care provider with primary practice located at 909 Walnut St 3Rd Floor, Cob, Philadelphia PA 19107-5211. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Diecidue, Robert J can be contacted via phone (215) 955-6215.

Contact Information

Primary practice address
909 Walnut St 3Rd Floor, Cob Philadelphia PA 19107-5211
Phone: (215) 955-6215
Fax: (215) 923-9189
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X DS026243L Pennsylvania
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery 204E00000X MD421272 Pennsylvania

Profile Details

NPI number 1225069818
LBN Legal business name Diecidue, Robert J
Credentials DMD, MD
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2006
Last updated Aug 23rd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1225069818 NPPES
Pennsylvania MEDICAID 0012768190002

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