Provider Demographics
NPI:1437381142
Name:SORELLE, CECILIA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:MARIE
Last Name:SORELLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12320 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2710
Mailing Address - Country:US
Mailing Address - Phone:718-441-0049
Mailing Address - Fax:718-441-0537
Practice Address - Street 1:12320 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2710
Practice Address - Country:US
Practice Address - Phone:718-441-0049
Practice Address - Fax:718-441-0537
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY50-0578161223G0001X
FLDN188401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice