Provider Demographics
NPI:1033248554
Name:SCERBO, PETER M (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:SCERBO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19390 COLLINS AVE
Mailing Address - Street 2:#201A
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2200
Mailing Address - Country:US
Mailing Address - Phone:305-936-9381
Mailing Address - Fax:
Practice Address - Street 1:6600 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-6450
Practice Address - Country:US
Practice Address - Phone:305-821-2611
Practice Address - Fax:305-556-0746
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN168401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice