Individual provider · NPI-1

Dr. Robert J Diecidue, DMD, MD

Oral & Maxillofacial Surgery · Philadelphia, PA

NPI number1225069818
StatusActive
Last updated in NPPESAug 23, 2019

Details

NPI
1225069818
Entity type
Individual (NPI-1)
Name
Dr. Robert J Diecidue
Credential
DMD, MD
Sex
Male
Sole proprietor
No
Enumeration date
Jul 5, 2006
Last updated
Aug 23, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
204E00000X Oral & Maxillofacial SurgeryMD421272PAYes
1223S0112X Dentist, Oral and Maxillofacial SurgeryDS026243LPA

Practice location

909 Walnut St
3rd Floor, Cob
Philadelphia, PA 19107-5211

Phone 215-955-6215 · Fax 215-923-9189

Mailing address

909 Walnut St
3rd Floor, Cob
Philadelphia, PA 19107-5211

Phone 215-955-6215 · Fax 215-923-9189

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