Healthcare Provider Details

I. General information

NPI: 1881879070
Provider Name (Legal Business Name): JOSEPH CECERE D.M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2008
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 RIDGMAR PLZ SUITE 108
FORT WORTH TX
76116-2689
US

IV. Provider business mailing address

2501 RIDGMAR PLZ SUITE 108
FORT WORTH TX
76116-2689
US

V. Phone/Fax

Practice location:
  • Phone: 817-731-8629
  • Fax: 817-732-0563
Mailing address:
  • Phone: 817-731-8629
  • Fax: 817-732-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14609
License Number StateTX

VIII. Authorized Official

Name: JOSEPH CECERE
Title or Position: ORAL AND MAXILLOFACIAL SURGEON
Credential: DMD
Phone: 817-731-8629