Provider Demographics
NPI:1437174232
Name:CIANCIOLA & BEACH PERIODONTAL GROUP
Entity Type:Organization
Organization Name:CIANCIOLA & BEACH PERIODONTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIANCIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:585-458-5456
Mailing Address - Street 1:2005 LYELL AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2323
Mailing Address - Country:US
Mailing Address - Phone:585-458-5456
Mailing Address - Fax:585-458-9782
Practice Address - Street 1:2005 LYELL AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2323
Practice Address - Country:US
Practice Address - Phone:585-458-5456
Practice Address - Fax:585-458-9782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030525-21223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty