Provider Demographics
NPI:1235303272
Name:CERASO, GREGORY F (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:F
Last Name:CERASO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 WESTOWN PKWY
Mailing Address - Street 2:SUITE 118
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6720
Mailing Address - Country:US
Mailing Address - Phone:515-223-1213
Mailing Address - Fax:
Practice Address - Street 1:4201 WESTOWN PKWY
Practice Address - Street 2:SUITE 118
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-6720
Practice Address - Country:US
Practice Address - Phone:515-223-1213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist