Healthcare Provider Details

I. General information

NPI: 1699149799
Provider Name (Legal Business Name): PETER M SCERBO, DMD, PA2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 NE 36TH ST STE 201
LIGHTHOUSE POINT FL
33064-7500
US

IV. Provider business mailing address

19390 COLLINS AVE APT 201A
SUNNY ISLES BEACH FL
33160-2229
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-2466
  • Fax: 954-941-0551
Mailing address:
  • Phone: 954-943-2466
  • Fax: 954-941-0551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER M SCERBO
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-886-4614