Healthcare Provider Details

I. General information

NPI: 1386577567
Provider Name (Legal Business Name): AMIR KAZZOUN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 20TH ST
VERO BEACH FL
32966-1020
US

IV. Provider business mailing address

5855 20TH ST
VERO BEACH FL
32966-1020
US

V. Phone/Fax

Practice location:
  • Phone: 561-396-2400
  • Fax:
Mailing address:
  • Phone: 561-396-2400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31768
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: