Provider Demographics
NPI:1750316451
Name:CEREZO-FALCO, MYRIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRIAM
Middle Name:
Last Name:CEREZO-FALCO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MYRIAM
Other - Middle Name:
Other - Last Name:CEREZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:295 BUCK ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-1748
Mailing Address - Country:US
Mailing Address - Phone:215-942-9090
Mailing Address - Fax:
Practice Address - Street 1:295 BUCK ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1748
Practice Address - Country:US
Practice Address - Phone:215-942-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026507L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry