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General NPI Number Information
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NPI Number | 1699879734
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Entity Type | Organization
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Legal Business Name | JERRY J CELLURA DDS LLP GERALD J CELLURA DMD LLP
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Dates
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Enumeration Date | 09/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 17 WEST AVE
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City | SPENCERPORT
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State | NY
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Zip | 14559
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Country | US
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Telephone | 585-352-4324
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Fax |
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Provider Business Mailing Address
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Address Line | 17 WEST AVE
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City | SPENCERPORT
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State | NY
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Zip | 14559
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Country | US
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Telephone | 585-352-4324
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JERRY J CELLURA
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Credential | DDS
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Telephone | 585-352-4324
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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 | 030815
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 050264
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License Number State | NY
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