Healthcare Provider Details

I. General information

NPI: 1528957461
Provider Name (Legal Business Name): ARMIN VAKILI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 07/02/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14407 SR 64
BRADENTON FL
34212
US

IV. Provider business mailing address

15115 21ST AVE E
BRADENTON FL
34212-8128
US

V. Phone/Fax

Practice location:
  • Phone: 202-999-9239
  • Fax:
Mailing address:
  • Phone: 202-999-9239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30509
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: