Provider Demographics
NPI:1528186996
Name:CELLO, PATRICK LEMAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LEMAY
Last Name:CELLO
Suffix:
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 1:5827 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2000
Mailing Address - Country:US
Mailing Address - Phone:561-844-9443
Mailing Address - Fax:561-472-9692
Practice Address - Street 1:2015 US HIGHWAY 441 N
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-1901
Practice Address - Country:US
Practice Address - Phone:863-763-1951
Practice Address - Fax:561-847-2305
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2016-08-18
Deactivation Date:2010-05-11
Deactivation Code:
Reactivation Date:2013-05-03
Provider Licenses
StateLicense IDTaxonomies
NY0416821223G0001X
FLDN205311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013526700Medicaid