Healthcare Provider Details

I. General information

NPI: 1386668051
Provider Name (Legal Business Name): JOHN P. CANCELLIERE & ASSOCIATES, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CROSSPOINTE DRIVE SUITE 2
NAPLES FL
34110
US

IV. Provider business mailing address

1001 CROSSPOINTE DRIVE SUITE 2
NAPLES FL
34110
US

V. Phone/Fax

Practice location:
  • Phone: 239-566-2422
  • Fax: 239-596-6614
Mailing address:
  • Phone: 239-566-2422
  • Fax: 239-596-6614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN15942
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN9163
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN9217
License Number StateFL

VIII. Authorized Official

Name: MR. JOHN PETER CANCELLIERE
Title or Position: DENTIST/OWNER
Credential: D.M.D.
Phone: 239-566-2422