MEDICARE: PETER M SCERBO, DMD, PA2

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1699149799
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER M SCERBO, DMD, PA2

Provider Business Mailing Address
First Line	:	19390 COLLINS AVE APT 201A
Second Line	:
City	:	SUNNY ISLES BEACH
State	:	FL
Zip	:	33160-2229
Country	:	US
Telephone Number	:	954-943-2466
Fax Number	:	954-941-0551

Provider Business Practice Location Address
First Line	:	2211 NE 36TH ST STE 201
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-7500
Country	:	US
Telephone Number	:	954-943-2466
Fax Number	:	954-941-0551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PETER M SCERBO
Credential	:	DMD
Telephone Number	:	973-886-4614

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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