Provider Demographics
NPI:1215264841
Name:VINCENT A. CESARIO DMD LLC
Entity type:Organization
Organization Name:VINCENT A. CESARIO DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CESARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-773-4204
Mailing Address - Street 1:28800 NYS RTE 3
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:13612-2140
Mailing Address - Country:US
Mailing Address - Phone:315-773-4204
Mailing Address - Fax:315-773-3126
Practice Address - Street 1:28800 NYS RTE 3
Practice Address - Street 2:
Practice Address - City:BLACK RIVER
Practice Address - State:NY
Practice Address - Zip Code:13612-2140
Practice Address - Country:US
Practice Address - Phone:315-773-4204
Practice Address - Fax:315-773-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY40430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty