Provider Demographics
NPI:1548232648
Name:MARCELLO, CRAIG (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:MARCELLO
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 1:400 RUSSELL AVE BLDG 41
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70143-5077
Mailing Address - Country:US
Mailing Address - Phone:504-678-7965
Mailing Address - Fax:
Practice Address - Street 1:400 RUSSELL AVE BLDG 41
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70143-5077
Practice Address - Country:US
Practice Address - Phone:504-678-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist