Provider Demographics
NPI:1275706426
Name:NASCIMENTO, MARCELLE MATOS (DDS)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:MATOS
Last Name:NASCIMENTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8780 MILLCREEK DR
Mailing Address - Street 2:
Mailing Address - City:EAST AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14051-2088
Mailing Address - Country:US
Mailing Address - Phone:352-273-5834
Mailing Address - Fax:352-682-3431
Practice Address - Street 1:8780 MILLCREEK DR
Practice Address - Street 2:
Practice Address - City:EAST AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14051-2088
Practice Address - Country:US
Practice Address - Phone:352-682-3431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDTP 4971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice