Provider Demographics
NPI:1851651095
Name:RALPH A, CIASULLO DMD PA
Entity Type:Organization
Organization Name:RALPH A, CIASULLO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:A
Authorized Official - Last Name:CIASULLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-795-4040
Mailing Address - Street 1:6220 MANATEE AVE W
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2376
Mailing Address - Country:US
Mailing Address - Phone:941-795-4040
Mailing Address - Fax:941-794-8139
Practice Address - Street 1:6220 MANATEE AVE W
Practice Address - Street 2:SUITE 304
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2376
Practice Address - Country:US
Practice Address - Phone:941-795-4040
Practice Address - Fax:941-794-8139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9834261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental