Provider Demographics
NPI:1760784854
Name:CERAVOLO & CORDERO
Entity Type:Organization
Organization Name:CERAVOLO & CORDERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PERIODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CERAVOLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-790-5700
Mailing Address - Street 1:1037 S STATE ROAD 7
Mailing Address - Street 2:SUITE 217
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6138
Mailing Address - Country:US
Mailing Address - Phone:561-790-5700
Mailing Address - Fax:561-790-5701
Practice Address - Street 1:1037 S STATE ROAD 7
Practice Address - Street 2:SUITE 217
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6138
Practice Address - Country:US
Practice Address - Phone:561-790-5700
Practice Address - Fax:561-790-5701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL107201223P0300X
FL126711223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty