DR. ROBERT J DIECIDUE (NPI# 1225069818) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225069818 |
| Entity Type | Individual |
| Full Name | DR. ROBERT J DIECIDUE |
| Credential | DMD, MD |
| Practice Address |
909 Walnut St 3rd Floor, Cob Philadelphia PA 19107-5211 |
| Practice Telephone | 2159556215 |
| Practice Fax Number | 2159239189 |
| Mailing Telephone | 2159556215 |
| Mailing Fax Number | 2159239189 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-08-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS026243L | PA | Dental Providers |
| Y | 204E00000X | Oral & Maxillofacial Surgery | MD421272 | PA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 0012768190002 | 05 |
| Street Address |
909 WALNUT ST 3RD FLOOR, COB |
| City | PHILADELPHIA |
| State | PA |
| Zip Code | 19107-5211 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720076706 | Jack I Jallo | Neurological Surgery | 909 Walnut St, 2nd Floor, Philadelphia, PA 19107-5211 | 2005-10-12 |
| 1598370876 | Adam Drabman | Student in an Organized Health Care Education/Training Program | 909 Walnut St, Philadelphia, PA 19107-5211 | 2020-09-13 |
| 1023639671 | Lauren Malinowski-falk | Nurse Practitioner | 909 Walnut St, Philadelphia, PA 19107-5211 | 2020-05-05 |
| 1104399336 | Claire Wells | Nurse Practitioner | 909 Walnut St, Philadelphia, PA 19107-5211 | 2019-01-10 |
| 1841768231 | Kimberly Farley | Nurse Practitioner | 909 Walnut St, Philadelphia, PA 19107-5211 | 2018-11-05 |
| 1477040558 | Tzu-ying Chuang | Student in an Organized Health Care Education/Training Program | 909 Walnut St, Philadelphia, PA 19107-5211 | 2018-04-16 |
| 1386170272 | Colleen Ellen Brophy | Student in an Organized Health Care Education/Training Program | 909 Walnut St, Room 300, Philadelphia, PA 19107-5211 | 2017-05-11 |
| 1760918874 | Yichao Ethan Zhao | Internal Medicine | 909 Walnut St, Philadelphia, PA 19107-5211 | 2017-05-10 |
| 1609302207 | Alyssa Gail Flashburg | Student in an Organized Health Care Education/Training Program | 909 Walnut St, Room 300, Philadelphia, PA 19107-5211 | 2017-05-03 |
| 1982139077 | Nikolaos Mouchtouris | Student in an Organized Health Care Education/Training Program | 909 Walnut St, 2nd Floor, Philadelphia, PA 19107-5211 | 2017-04-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578170940 | Stephanie Quist | Pharmacist | 1 S Broad Street, Philadelphia, PA 19107 | 2020-09-29 |
| 1457968448 | Cloudline Physical Therapy LLC | Physical Therapist | 239-241 South 10th St, Philadelphia, PA 19107 | 2020-09-24 |
| 1053931303 | Wilson Wong | Pharmacist | Cvs Pharmacy #450, 3401 Walnut St, Philadelphia, PA 19107 | 2020-04-16 |
| 1326608779 | Pascal Lavergne | Neurological Surgery | 111 11th St, Thomas Jefferson University, Philadelphia, PA 19107 | 2019-06-18 |
| 1639632185 | Taylor D'amore | Orthopaedic Surgery | 925 Chest Street 5th Floor, Philadelphia, PA 19107 | 2019-04-11 |
| 1043779630 | Heather Lynn Yenser | Nurse Practitioner | 111 S. 11th St., Jefferson Vascular Center (6th Floor), Philadelphia, PA 19107 | 2019-03-14 |
| 1174093702 | Jennifer Lynn Kengeter | Psychologist | 900 Walnut Street, Suite 200, Philadelphia, PA 19107 | 2018-11-27 |
| 1649751843 | Rachel Wint | Physician Assistant | 231 N Broad St Fl 2, Philadelphia, PA 19107 | 2018-08-24 |
| 1922588623 | Hyung Bin Lee | Dentist | 315 N 12th St, Apt 803, Philadelphia, PA 19107 | 2018-08-21 |
| 1750860490 | Anastasiya Khlypnych | Physician Assistant | 111 S. 11th Street, Suite 2170, Gibbon Bldg Suite 6210, Philadelphia, PA 19107 | 2018-08-13 |
| Find all providers in zip 19107 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376990853 | Center City Oral & Maxillofacial Surgery | Oral & Maxillofacial Surgery | 1740 South St Ste 302, Philadelphia, PA 19146-1572 | 2016-05-16 |
| 1730268079 | Children's Surgical Associates Ltd | Oral & Maxillofacial Surgery | 34th & Civc Center Blvd, Children's Hospital of Philadelphia, Philadelphia, PA 19104 | 2006-11-06 |
| 1598724288 | Gerard T. Dowd | Oral & Maxillofacial Surgery | 9525 Frankford Ave, Philadelphia, PA 19114-2812 | 2006-03-21 |
| 1245885060 | Sean Jia Hoong Lim | Oral & Maxillofacial Surgery | 909 Walnut St Fl 3, Philadelphia, PA 19107-5211 | 2019-08-08 |
| 1457706608 | Katherine Alden Doan France | Oral & Maxillofacial Surgery | 3400 Civic Center Blvd, South Pavilion, 4th Floor, Philadelphia, PA 19104-5127 | 2016-04-25 |
| 1942573902 | Maxillofacial Surgical Associates, P.C. | Oral & Maxillofacial Surgery | 1601 Walnut St, Suite 1116, Philadelphia, PA 19102-2944 | 2012-02-21 |
| 1811202633 | Rabie M Shanti | Oral & Maxillofacial Surgery | 3400 Civic Center Blvd, South Pavilion, 3rd Floor, Philadelphia, PA 19104-5127 | 2010-08-17 |
| 1649506577 | Takako Tanaka | Oral & Maxillofacial Surgery | 3400 Civic Center Blvd, 4th Floor, South Pavilion, Philadelphia, PA 19104-5127 | 2009-10-28 |
| 1922237981 | Neeraj H. Panchal | Oral & Maxillofacial Surgery | 3400 Civic Center Blvd., 4th Floor, South Pavilion, Philadelphia, PA 19104 | 2009-07-10 |
| 1023244654 | Steven W Wang | Oral & Maxillofacial Surgery | 3400 Spruce St, One Maloney, Philadelphia, PA 19104-4206 | 2009-06-10 |
| Find all providers in PHILADELPHIA | ||||
| City | PHILADELPHIA |
| Zip Code | 19107 |
Please comment or provide details below to improve the information on DR. ROBERT J DIECIDUE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.