Provider Demographics
NPI:1619199023
Name:CERILLO, LOUIS P (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:P
Last Name:CERILLO
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15277 AMBERLY DR
Mailing Address - Street 2:SOMERSET PROFESSIONAL PARK
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-2155
Mailing Address - Country:US
Mailing Address - Phone:813-971-1688
Mailing Address - Fax:813-971-4322
Practice Address - Street 1:15277 AMBERLY DR
Practice Address - Street 2:SOMERSET PROFESSIONAL PARK
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2155
Practice Address - Country:US
Practice Address - Phone:813-971-1688
Practice Address - Fax:813-971-4322
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN115741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice