MEDICARE: VIBHOR IDNANI DMD

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	1223G0001X	General Practice Dentistry	DN20961	FL

General Provider Information

NPI Number	:	1477953677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIBHOR IDNANI DMD

Provider Business Mailing Address
First Line	:	16235 US HIGHWAY 441
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2736
Country	:	US
Telephone Number	:	561-637-4443
Fax Number	:

Provider Business Practice Location Address
First Line	:	16235 US HIGHWAY 441
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2736
Country	:	US
Telephone Number	:	561-637-4443
Fax Number	:

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

Provider Enumeration Date	:	08/26/2014
Last Update Date	:	07/11/2022

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