Provider Demographics
NPI:1366997884
Name:CERON, DENISE NOEMY (DMD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:NOEMY
Last Name:CERON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2310 HENRY CLOWER BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5776
Mailing Address - Country:US
Mailing Address - Phone:770-972-2000
Mailing Address - Fax:770-979-5000
Practice Address - Street 1:2310 HENRY CLOWER BLVD STE C
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5776
Practice Address - Country:US
Practice Address - Phone:770-972-2000
Practice Address - Fax:770-979-5000
Is Sole Proprietor?:No
Enumeration Date:2016-08-25
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015233122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist