Provider Demographics
NPI:1922536853
Name:LOUIS P CERILLO, DDS, PA
Entity Type:Organization
Organization Name:LOUIS P CERILLO, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:CERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:813-971-1688
Mailing Address - Street 1:15277 AMBERLY DR
Mailing Address - Street 2:
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-23
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN11574261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental