Provider Demographics
NPI:1831213008
Name:MARCELLI, RUDY EMILIO (DDS)
Entity type:Individual
Prefix:DR
First Name:RUDY
Middle Name:EMILIO
Last Name:MARCELLI
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 1:1409 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3409
Mailing Address - Country:US
Mailing Address - Phone:814-944-6611
Mailing Address - Fax:814-944-9570
Practice Address - Street 1:1409 13TH ST
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3409
Practice Address - Country:US
Practice Address - Phone:814-944-6611
Practice Address - Fax:814-944-9570
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADSO15921L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice