Provider Demographics
NPI:1245274216
Name:CERMINARA, JOHN W (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:CERMINARA
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 1:1341 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-1401
Mailing Address - Country:US
Mailing Address - Phone:814-453-6374
Mailing Address - Fax:814-456-5372
Practice Address - Street 1:1341 W 26TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-1401
Practice Address - Country:US
Practice Address - Phone:814-453-6374
Practice Address - Fax:814-456-5372
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028747L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00145825900002Medicaid