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General NPI Number Information
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NPI Number | 1225573066
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Entity Type | Organization
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Legal Business Name | SMILE VIERA
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Dates
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Enumeration Date | 01/04/2017
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Last Update Date | 01/04/2017
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Provider Practice Location Address
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Address Line | 5455 MURRELL RD STE 108
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City | ROCKLEDGE
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State | FL
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Zip | 32955-6615
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Country | US
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Telephone | 321-631-9395
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Fax | 321-632-8581
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Provider Business Mailing Address
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Address Line | 5455 MURRELL RD STE 108
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City | ROCKLEDGE
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State | FL
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Zip | 32955-6615
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Country | US
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Telephone | 321-631-9395
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Fax | 321-632-8581
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Authorized Official
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Title or Position | INSURANCE AND BILLING COORDINATOR
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Name | ASHELEY JORDAN
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Credential |
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Telephone | 321-631-9395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | FL
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