Provider Demographics
NPI:1104258417
Name:CERULLO, DOMENICK ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:DOMENICK
Middle Name:ANDREW
Last Name:CERULLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10150 HAGEN RANCH ROAD SUITE 202
Mailing Address - Street 2:DENTAL ARTS OF BOYNTON BEACH, P.A.
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-767-9595
Mailing Address - Fax:561-767-9569
Practice Address - Street 1:10150 HAGEN RANCH ROAD SUITE 202
Practice Address - Street 2:DENTAL ARTS OF BOYNTON BEACH, P.A.
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-767-9595
Practice Address - Fax:561-767-9569
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN211261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice