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General NPI Number Information
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NPI Number | 1972517712
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Entity Type | Organization
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Legal Business Name | JOHN D. CERCEK, D.D.S.
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3140 DUSTIN ROAD
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City | OREGON
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State | OH
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Zip | 43616
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Country | US
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Telephone | 419-698-3782
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Fax | 419-698-9560
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Provider Business Mailing Address
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Address Line | 3140 DUSTIN ROAD
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City | OREGON
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State | OH
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Zip | 43616
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Country | US
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Telephone | 419-698-3782
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Fax | 419-698-9560
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JOHN D. CERCEK
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Credential | D.D.S., M.S.
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Telephone | 419-698-3782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 30012421
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License Number State | OH
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