Provider Demographics
NPI:1386668051
Name:JOHN P. CANCELLIERE & ASSOCIATES, DMD, LLC
Entity type:Organization
Organization Name:JOHN P. CANCELLIERE & ASSOCIATES, DMD, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CANCELLIERE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:239-566-2422
Mailing Address - Street 1:1001 CROSSPOINTE DRIVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110
Mailing Address - Country:US
Mailing Address - Phone:239-566-2422
Mailing Address - Fax:239-596-6614
Practice Address - Street 1:1001 CROSSPOINTE DRIVE
Practice Address - Street 2:SUITE 2
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110
Practice Address - Country:US
Practice Address - Phone:239-566-2422
Practice Address - Fax:239-596-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15942122300000X
FLDN91631223E0200X
FLDN92171223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty