1649275074 NPI number — DR. JOSEPH PATRICK SCIARRA D.D.S.

Table of content: DR. JOSEPH PATRICK SCIARRA D.D.S. (NPI 1649275074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649275074 NPI number — DR. JOSEPH PATRICK SCIARRA D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCIARRA
Provider First Name:
JOSEPH
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649275074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
03/24/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22554 VENTURA BLVD
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
WOODLAND HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91364-1433
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-224-2970
Provider Business Mailing Address Fax Number:
818-224-2980

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22554 VENTURA BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
WOODLAND HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91364-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-224-2970
Provider Business Practice Location Address Fax Number:
818-224-2980
Provider Enumeration Date:
06/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  27835 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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