Healthcare Provider Details

I. General information

NPI: 1992713911
Provider Name (Legal Business Name): HOSPITAL DENISTRY FOR THE CHILDREN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 35TH AVE
VERO BEACH FL
32960
US

IV. Provider business mailing address

2000 35TH AVE
VERO BEACH FL
32960
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 TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN13774
License Number StateFL

VIII. Authorized Official

Name: DR. FRANCIS JOSEPH DERMODY JR.
Title or Position: PRESIDENT
Credential: DMD
Phone: 772-562-5150