MEDICARE: DR. JOSEPH CERAVOLO DDS

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	1223E0200X	Endodontics	48583	CA

General Provider Information

NPI Number	:	1548328164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH CERAVOLO DDS

Provider Business Mailing Address
First Line	:	322 CULVER BLVD STE 274
Second Line	:
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-7704
Country	:	US
Telephone Number	:	310-998-7522
Fax Number	:

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E STE 1801
Second Line	:
City	:	CENTURY CITY
State	:	CA
Zip	:	90067-2021
Country	:	US
Telephone Number	:	310-717-5932
Fax Number	:	310-553-5952

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/13/2020

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