Provider Demographics
NPI:1548328164
Name:CERAVOLO, JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:CERAVOLO
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 1:322 CULVER BLVD STE 274
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7704
Mailing Address - Country:US
Mailing Address - Phone:310-998-7522
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1801
Practice Address - Street 2:
Practice Address - City:CENTURY CITY
Practice Address - State:CA
Practice Address - Zip Code:90067-2021
Practice Address - Country:US
Practice Address - Phone:310-717-5932
Practice Address - Fax:310-553-5952
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics