Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS-018464-L | PA |
NPI | 1194931824 |
---|---|
Provider Name | Stuart Alan Cerato |
First Address | Philadelphia, PA 19116-2513 |
Second Address | Philadelphia, PA 19116-2513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 08/07/2007 |