MEDICARE: JOE M CREEL, 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN4076	FL

General Provider Information

NPI Number	:	1073607057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOE M CREEL, DDS, PA

Provider Business Mailing Address
First Line	:	100 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4303
Country	:	US
Telephone Number	:	321-723-8821
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 W NEW HAVEN AVE
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4303
Country	:	US
Telephone Number	:	321-723-8821
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	JOE M CREEL
Credential	:	DDS, MS
Telephone Number	:	321-723-8821

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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