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General NPI Number Information
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NPI Number | 1760784854
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Entity Type | Organization
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Legal Business Name | CERAVOLO & CORDERO
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 1037 S STATE ROAD 7 SUITE 217
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City | WELLINGTON
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State | FL
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Zip | 33414-6138
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Country | US
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Telephone | 561-790-5700
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Fax | 561-790-5701
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Provider Business Mailing Address
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Address Line | 1037 S STATE ROAD 7 SUITE 217
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City | WELLINGTON
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State | FL
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Zip | 33414-6138
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Country | US
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Telephone | 561-790-5700
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Fax | 561-790-5701
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Authorized Official
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Title or Position | PERIODONTIST
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Name | DR. JOSEPH JAMES CERAVOLO
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Credential | D.D.S.
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Telephone | 561-790-5700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12671
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 10720
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License Number State | FL
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