Healthcare Provider Details

I. General information

NPI: 1487889572
Provider Name (Legal Business Name): VERO BEACH SURGICAL ARTS P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 10/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 37TH PL STE 103
VERO BEACH FL
32960-6579
US

IV. Provider business mailing address

P.O. BOX 162906
MIAMI FL
33116-2906
US

V. Phone/Fax

Practice location:
  • Phone: 772-770-9191
  • Fax: 772-770-4161
Mailing address:
  • Phone: 772-770-9191
  • Fax: 772-770-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ANDREW COLGAN
Title or Position: OWNER
Credential: DDS
Phone: 772-770-9191