Provider Demographics
NPI:1568083020
Name:CERMENO, RICARDO J SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:J
Last Name:CERMENO
Suffix:SR
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 1:6509 CONROY RD APT 114
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3501
Mailing Address - Country:US
Mailing Address - Phone:407-607-2325
Mailing Address - Fax:
Practice Address - Street 1:6509 CONROY RD APT 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3501
Practice Address - Country:US
Practice Address - Phone:407-607-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-0178611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice