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General NPI Number Information
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NPI Number | 1144986316
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Entity Type | Organization
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Legal Business Name | VIBRANT ORTHODONTICS, PLLC
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Dates
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Enumeration Date | 11/12/2021
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 1350 THOMASWOOD DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7914
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Country | US
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Telephone | 850-385-8101
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 THOMASWOOD DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7914
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Country | US
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Telephone | 850-385-8101
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MARYAM REZAIE
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Credential | DMD
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Telephone | 850-385-8101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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