Provider Demographics
NPI:1730265778
Name:CERMINARO, MICHAEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:CERMINARO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:755 SEMINOLE ROAD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49441-6561
Mailing Address - Country:US
Mailing Address - Phone:231-780-1100
Mailing Address - Fax:231-780-1931
Practice Address - Street 1:755 SEMINOLE ROAD
Practice Address - Street 2:SUITE 102
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49441-6561
Practice Address - Country:US
Practice Address - Phone:231-780-1100
Practice Address - Fax:231-780-1931
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI0143861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice