MEDICARE: JAROSLAW CEGIELSKI D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN16148	FL

General Provider Information

NPI Number	:	1215046446
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAROSLAW CEGIELSKI D.M.D.

Provider Business Mailing Address
First Line	:	150 SW CHAMBER CT
Second Line	:	SUITE 201
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3413
Country	:	US
Telephone Number	:	772-336-8253
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 SW CHAMBER CT
Second Line	:	SUITE 201
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34986-3413
Country	:	US
Telephone Number	:	772-336-8253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/09/2013

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