Provider Demographics
NPI:1205224011
Name:VACCAREZZA, JOEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:
Last Name:VACCAREZZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:SUITE #308
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:305-757-6991
Mailing Address - Fax:
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE #308
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-757-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 170341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice