Provider Demographics
NPI:1013567387
Name:DENTIHEALTH LLC
Entity Type:Organization
Organization Name:DENTIHEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAROSLAW
Authorized Official - Middle Name:
Authorized Official - Last Name:CEGIELSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:772-336-8253
Mailing Address - Street 1:150 SW CHAMBER CT STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3413
Mailing Address - Country:US
Mailing Address - Phone:772-336-8253
Mailing Address - Fax:
Practice Address - Street 1:150 SW CHAMBER CT STE 201
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3413
Practice Address - Country:US
Practice Address - Phone:772-336-8253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-18
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental