MEDICARE: DR. IVAN E VEGA DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN17333	FL

General Provider Information

NPI Number	:	1023208147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN E VEGA DDS

Provider Business Mailing Address
First Line	:	123 N POWERLINE RD
Second Line	:	STE #A-6
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8037
Country	:	US
Telephone Number	:	954-427-2436
Fax Number	:	954-429-0900

Provider Business Practice Location Address
First Line	:	123 N POWERLINE RD
Second Line	:	STE #A-6
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-8037
Country	:	US
Telephone Number	:	954-427-2436
Fax Number	:	954-429-0900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	07/25/2007

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