Provider Demographics
NPI:1629082037
Name:JOEL SCALERA DDS PA
Entity Type:Organization
Organization Name:JOEL SCALERA DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:CAMERON
Authorized Official - Last Name:SCALERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:321-259-3283
Mailing Address - Street 1:3945 WILD PINE LN
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-6218
Mailing Address - Country:US
Mailing Address - Phone:321-459-2286
Mailing Address - Fax:
Practice Address - Street 1:33 SUNTREE PL
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7602
Practice Address - Country:US
Practice Address - Phone:321-259-3283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10620261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental