1730335738 NPI number — DR. JENNIFER CHRISTINE CAROSELLI DDS

Table of content: DR. JENNIFER CHRISTINE CAROSELLI DDS (NPI 1730335738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730335738 NPI number — DR. JENNIFER CHRISTINE CAROSELLI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAROSELLI
Provider First Name:
JENNIFER
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNER
Provider Other First Name:
JENNIFER
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730335738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6536 ANTHONY DRIVE SUITE A
Provider Second Line Business Mailing Address:
VICTOR DENTAL CARE
Provider Business Mailing Address City Name:
EAST VICTOR PLACE/ VICTOR
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14564
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-924-8940
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6536 ANTHONY DRIVE SUITE A
Provider Second Line Business Practice Location Address:
VICTOR DENTAL CARE
Provider Business Practice Location Address City Name:
EAST VICTOR PLACE/ VICTOR
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14564
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-924-8940
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  053983-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)