MEDICARE: PATRICK RYAN CECOLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	122300000X	Dentist	7419	LA

General Provider Information

NPI Number	:	1043910276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK RYAN CECOLA

Provider Business Mailing Address
First Line	:	808 ATHERTON DR
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-5544
Country	:	US
Telephone Number	:	504-875-8148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1291 FLORIDA AVE SW
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-4635
Country	:	US
Telephone Number	:	225-664-4121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	05/31/2023

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Directions to “ PATRICK RYAN CECOLA ” Practice Location

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