Provider Demographics
NPI:1699879734
Name:JERRY J CELLURA DDS LLP GERALD J CELLURA DMD LLP
Entity type:Organization
Organization Name:JERRY J CELLURA DDS LLP GERALD J CELLURA DMD LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CELLURA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-352-4324
Mailing Address - Street 1:17 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-352-4324
Mailing Address - Fax:
Practice Address - Street 1:17 WEST AVE
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-352-4324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030815122300000X
NY050264122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty