MEDICARE: VANESSA MATAMOROS MENA 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	1223P0221X	Pediatric Dentistry	DN25067	FL

General Provider Information

NPI Number	:	1548893936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA MATAMOROS MENA DMD

Provider Business Mailing Address
First Line	:	14197 SW PINNACLE CT
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-6103
Country	:	US
Telephone Number	:	772-528-3432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1955 POINTE WEST DR
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-567-5100
Fax Number	:

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

Provider Enumeration Date	:	02/13/2020
Last Update Date	:	11/14/2025

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