Provider Demographics
NPI:1861553778
Name:CIANCIOLA, LOUIS J (DDS,MS)
Entity type:Individual
Prefix:
First Name:LOUIS
Middle Name:J
Last Name:CIANCIOLA
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 LYELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14606-2323
Mailing Address - Country:US
Mailing Address - Phone:585-458-5456
Mailing Address - Fax:585-458-9782
Practice Address - Street 1:2005 LYELL AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14606-2323
Practice Address - Country:US
Practice Address - Phone:585-458-5456
Practice Address - Fax:585-458-9782
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics