Provider Demographics
NPI:1770642787
Name:FERULLO, JOHN ANTHONY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:FERULLO
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BANK OF AMERICA TOWER ONE PROGRESS PLAZA
Mailing Address - Street 2:SUITE 830
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:727-822-8101
Mailing Address - Fax:727-822-8206
Practice Address - Street 1:BANK OF AMERICA TOWER ONE PROGRESS PLAZA
Practice Address - Street 2:SUITE 830
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-822-8101
Practice Address - Fax:727-822-8206
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0011257122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist