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General NPI Number Information
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NPI Number | 1306142260
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Entity Type | Organization
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Legal Business Name | ANNY B. VERA D.D.S., M.SC., P.A
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 1667 N CLYDE MORRIS BLVD # 1
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5500
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Country | US
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Telephone | 386-274-2021
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Fax | 386-274-1743
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Provider Business Mailing Address
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Address Line | 1667 N CLYDE MORRIS BLVD # 1
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5500
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Country | US
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Telephone | 386-274-2021
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Fax | 386-274-1743
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANNY B VERA
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Credential | D.D.S.
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Telephone | 386-274-2021
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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 | DN15075
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License Number State | FL
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