MEDICARE: DR. JOEL E. VACCAREZZA DDS PA

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1023296753
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. JOEL E. VACCAREZZA DDS PA

Provider Business Mailing Address
First Line	:	9999 NE 2ND AVE STE 308
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2346
Country	:	US
Telephone Number	:	305-757-6991
Fax Number	:	305-757-0042

Provider Business Practice Location Address
First Line	:	9999 NE 2ND AVE STE 308
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-2346
Country	:	US
Telephone Number	:	305-757-6991
Fax Number	:	305-757-0042

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEL E VACCAREZZA
Credential	:	DDS
Telephone Number	:	305-757-6991

Provider Enumeration Date	:	02/05/2008
Last Update Date	:	02/05/2008

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