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General NPI Number Information
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NPI Number | 1104517143
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Entity Type | Individual
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Provider Name | CHASE JAMES CERBONE DMD
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Gender | Male
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Dates
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Enumeration Date | 05/19/2023
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Last Update Date | 05/19/2023
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Provider Practice Location Address
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Address Line | 155 SW PORT ST LUCIE BLVD
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34984-5039
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Country | US
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Telephone | 772-621-2492
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Fax |
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Provider Business Mailing Address
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Address Line | 538 ROOKERY PL
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City | JUPITER
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State | FL
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Zip | 33458-8368
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Country | US
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Telephone | 561-319-7209
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN27878
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License Number State | FL
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