Healthcare Provider Details

I. General information

NPI: 1184698045
Provider Name (Legal Business Name): DERMODY PEDIATRIC DENTISTRY & ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 35TH AVE
VERO BEACH FL
32960-2442
US

IV. Provider business mailing address

2000 35TH AVE
VERO BEACH FL
32960-2442
US

V. Phone/Fax

Practice location:
  • Phone: 772-562-5150
  • Fax: 772-562-2711
Mailing address:
  • Phone: 772-562-5150
  • Fax: 772-562-2711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MRS. LOIS DERMODY
Title or Position: MANAGER
Credential:
Phone: 772-562-5150