Provider Demographics
NPI:1700564754
Name:DE SOUZA PEREIRA, CYBELLE LUISA (DMD)
Entity Type:Individual
Prefix:DR
First Name:CYBELLE LUISA
Middle Name:
Last Name:DE SOUZA PEREIRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CYBELLE
Other - Middle Name:
Other - Last Name:PEREIRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3611 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16150-9242
Mailing Address - Country:US
Mailing Address - Phone:929-355-8974
Mailing Address - Fax:929-355-8974
Practice Address - Street 1:264 NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2529
Practice Address - Country:US
Practice Address - Phone:724-285-4153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0442131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice