Healthcare Provider Details

I. General information

NPI: 1548618523
Provider Name (Legal Business Name): KEVIN SCOTT VAKANI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 40TH AVE STE 4
VERO BEACH FL
32960-2467
US

IV. Provider business mailing address

2112 NEW HAMPSHIRE AVE NW APT 908
WASHINGTON DC
20009-6529
US

V. Phone/Fax

Practice location:
  • Phone: 772-400-1304
  • Fax:
Mailing address:
  • Phone: 772-206-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN21191
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: