Provider Demographics
NPI:1972035939
Name:CERAOLO-O'DONNELL, SUMMER ROSE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUMMER
Middle Name:ROSE
Last Name:CERAOLO-O'DONNELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-3931
Mailing Address - Country:US
Mailing Address - Phone:410-788-4555
Mailing Address - Fax:410-744-0142
Practice Address - Street 1:1134 N ROLLING RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3931
Practice Address - Country:US
Practice Address - Phone:410-788-4555
Practice Address - Fax:410-744-0142
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL8371223P0221X
MD169131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid