Provider Demographics
NPI:1851514038
Name:ERCOLANI, JOSEPH FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:FRED
Last Name:ERCOLANI
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 1:609 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PECKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18452-2345
Mailing Address - Country:US
Mailing Address - Phone:570-383-2463
Mailing Address - Fax:570-383-3699
Practice Address - Street 1:609 MAIN ST
Practice Address - Street 2:
Practice Address - City:PECKVILLE
Practice Address - State:PA
Practice Address - Zip Code:18452-2345
Practice Address - Country:US
Practice Address - Phone:570-383-2463
Practice Address - Fax:570-383-3699
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021151L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice