Provider Demographics
NPI:1881879070
Name:JOSEPH CECERE D.M.D.,INC.
Entity type:Organization
Organization Name:JOSEPH CECERE D.M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CECERE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-731-8629
Mailing Address - Street 1:2501 RIDGMAR PLZ
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-2689
Mailing Address - Country:US
Mailing Address - Phone:817-731-8629
Mailing Address - Fax:817-732-0563
Practice Address - Street 1:2501 RIDGMAR PLZ
Practice Address - Street 2:SUITE 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-2689
Practice Address - Country:US
Practice Address - Phone:817-731-8629
Practice Address - Fax:817-732-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146091223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12590Medicare UPIN
TX83M212Medicare PIN