Provider Demographics
NPI:1730335738
Name:CAROSELLI, JENNIFER CHRISTINE (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:CAROSELLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:CHRISTINE
Other - Last Name:BERNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6536 ANTHONY DRIVE SUITE A
Mailing Address - Street 2:VICTOR DENTAL CARE
Mailing Address - City:EAST VICTOR PLACE/ VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564
Mailing Address - Country:US
Mailing Address - Phone:585-924-8940
Mailing Address - Fax:
Practice Address - Street 1:6536 ANTHONY DRIVE SUITE A
Practice Address - Street 2:VICTOR DENTAL CARE
Practice Address - City:EAST VICTOR PLACE/ VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564
Practice Address - Country:US
Practice Address - Phone:585-924-8940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053983-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice