Provider Demographics
NPI:1336210533
Name:CELLINI, PERRY ERMINIO (DDS)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:ERMINIO
Last Name:CELLINI
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 1:2845 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-3491
Mailing Address - Country:US
Mailing Address - Phone:313-561-0500
Mailing Address - Fax:313-561-0553
Practice Address - Street 1:2845 MONROE ST
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-3491
Practice Address - Country:US
Practice Address - Phone:313-561-0500
Practice Address - Fax:313-561-0553
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0141901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice