Provider Demographics
NPI:1114931920
Name:CERVENY, ERVIN CHARLES I (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERVIN
Middle Name:CHARLES
Last Name:CERVENY
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 16TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-5342
Mailing Address - Country:US
Mailing Address - Phone:727-421-9800
Mailing Address - Fax:
Practice Address - Street 1:3610 16TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-5342
Practice Address - Country:US
Practice Address - Phone:727-421-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN91691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070974300Medicaid