Provider Demographics
NPI:1215046446
Name:CEGIELSKI, JAROSLAW (DMD)
Entity type:Individual
Prefix:
First Name:JAROSLAW
Middle Name:
Last Name:CEGIELSKI
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 1:150 SW CHAMBER CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3413
Mailing Address - Country:US
Mailing Address - Phone:772-336-8253
Mailing Address - Fax:
Practice Address - Street 1:150 SW CHAMBER CT
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3413
Practice Address - Country:US
Practice Address - Phone:772-336-8253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist