Healthcare Provider Details

I. General information

NPI: 1366066011
Provider Name (Legal Business Name): ARIEL CELESTE GAROFALO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 LIBERTY ST
PERRYOPOLIS PA
15473-1828
US

IV. Provider business mailing address

PO BOX 363
PERRYOPOLIS PA
15473-0363
US

V. Phone/Fax

Practice location:
  • Phone: 724-736-2550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS042681
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: