Provider Demographics
NPI:1174157945
Name:CHICCONE, ERIC (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:CHICCONE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 WASHINGTON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1995
Mailing Address - Country:US
Mailing Address - Phone:973-667-6844
Mailing Address - Fax:
Practice Address - Street 1:187 WASHINGTON AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1995
Practice Address - Country:US
Practice Address - Phone:973-667-5844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI030232011223S0112X
NJ22DI030232001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery