Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DS021854L | PA |
NPI | 1033135884 |
---|---|
Provider Name | Lennie M Checchio |
First Address | Philadelphia, PA 19114-2812 |
Second Address | Philadelphia, PA 19114-2812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2006 |
Last Update Date | 08/07/2007 |