IndividualActive
Robert Diecidue, DMD, MD
NPI 1225069818 · Oral & Maxillofacial Surgery (D.M.D.) · Philadelphia, PA
Provider details
- NPI number
- 1225069818
- Entity type
- Individual
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.)Allopathic & Osteopathic Physicians
- Credential
- DMD, MD
- Sex
- Male
- Sole proprietor
- No
- License
- DS026243L (PA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Dental Providers
Practice location
909 Walnut St
3rd Floor, Cob
Philadelphia, PA 19107-5211
Phone: (215) 955-6215
Fax: (215) 923-9189
Approximate (ZIP-level) locationGet directions
Mailing address
909 Walnut St
Philadelphia, PA 19107-5211
Registry dates
- Enumerated
- 2006-07-05
- Last updated
- 2019-08-23
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.