Provider Demographics
NPI:1043612393
Name:JACQUELINE MACY CERAR DDS INC.
Entity Type:Organization
Organization Name:JACQUELINE MACY CERAR DDS INC.
Other - Org Name:MACY FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MACY
Authorized Official - Last Name:CERAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:440-255-8133
Mailing Address - Street 1:9485 MENTOR AVE
Mailing Address - Street 2:SUITE 112
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-4597
Mailing Address - Country:US
Mailing Address - Phone:440-255-8133
Mailing Address - Fax:440-867-3310
Practice Address - Street 1:9485 MENTOR AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-4597
Practice Address - Country:US
Practice Address - Phone:440-255-8133
Practice Address - Fax:440-867-3310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21029122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty