Provider Demographics
NPI:1023296753
Name:DR. JOEL E. VACCAREZZA DDS PA
Entity type:Organization
Organization Name:DR. JOEL E. VACCAREZZA 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:E
Authorized Official - Last Name:VACCAREZZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-757-6991
Mailing Address - Street 1:9999 NE 2ND AVE STE 308
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2346
Mailing Address - Country:US
Mailing Address - Phone:305-757-6991
Mailing Address - Fax:305-757-0042
Practice Address - Street 1:9999 NE 2ND AVE STE 308
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2346
Practice Address - Country:US
Practice Address - Phone:305-757-6991
Practice Address - Fax:305-757-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty