Healthcare Provider Details

I. General information

NPI: 1205224011
Provider Name (Legal Business Name): JOEL VACCAREZZA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 12/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9999 NE 2ND AVE SUITE #308
MIAMI SHORES FL
33138-2352
US

IV. Provider business mailing address

9999 NE 2ND AVE SUITE #308
MIAMI SHORES FL
33138-2352
US

V. Phone/Fax

Practice location:
  • Phone: 305-757-6991
  • Fax:
Mailing address:
  • Phone: 305-757-6991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 17034
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: