Provider Demographics
NPI:1023232352
Name:CHIARELLO, EDWARD V (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:V
Last Name:CHIARELLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21300 BRINSON AVE
Mailing Address - Street 2:APT 211
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-5046
Mailing Address - Country:US
Mailing Address - Phone:941-743-2250
Mailing Address - Fax:
Practice Address - Street 1:14651 PALM BEACH BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2331
Practice Address - Country:US
Practice Address - Phone:239-694-9993
Practice Address - Fax:239-694-9995
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist