Provider Demographics
NPI:1043219108
Name:MORICONI, E. STEVEN (DMD)
Entity type:Individual
Prefix:DR
First Name:E.
Middle Name:STEVEN
Last Name:MORICONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 HARPER AVE
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3206
Mailing Address - Country:US
Mailing Address - Phone:215-884-8263
Mailing Address - Fax:215-886-8975
Practice Address - Street 1:609 HARPER AVE
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3206
Practice Address - Country:US
Practice Address - Phone:215-884-8263
Practice Address - Fax:215-886-8975
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-20
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021089L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427879F79OtherMEDICARE RENDERING PROVID
PA17815OtherAETNA
PA427879OtherIBC/HIGHMARK BLUE SHIELD
PA17815OtherAETNA
PA158100Medicare ID - Type Unspecified