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NPI Code Detail

MEDICARE: DR. KEITH LAWRENCE VEVERA D.M.D.

MEDICARE: DR. KEITH LAWRENCE VEVERA D.M.D.
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
11223G0001XGeneral Practice Dentistry13762FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
156776OTHERFLBCBS
2836728OTHERFLUNITED CONCORDIA

General Provider Information

NPI Number : 1275632622
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH LAWRENCE VEVERA D.M.D.
Provider Business Mailing Address
First Line : 7602 W SAND LAKE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5112
Country : US
Telephone Number : 407-826-1234
Fax Number : 407-826-1234
Provider Business Practice Location Address
First Line : 7602 W SAND LAKE RD
Second Line :
City : ORLANDO
State : FL
Zip : 32819-5112
Country : US
Telephone Number : 407-826-1234
Fax Number : 407-826-1234
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2006
Last Update Date : 04/08/2014

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