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General NPI Number Information
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NPI Number | 1457791238
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Entity Type | Organization
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Legal Business Name | TIM M. VERWEST, D.M.D., P.A.
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Dates
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Enumeration Date | 06/26/2013
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Last Update Date | 06/26/2013
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Provider Practice Location Address
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Address Line | 9371 CYPRESS LAKE DR SUITE 7
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City | FORT MYERS
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State | FL
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Zip | 33919-4939
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Country | US
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Telephone | 239-482-2722
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Fax |
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Provider Business Mailing Address
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Address Line | 9371 CYPRESS LAKE DR SUITE 7
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City | FORT MYERS
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State | FL
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Zip | 33919-4939
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Country | US
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Telephone | 239-482-2722
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TIM VERWEST
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Credential | DMD
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Telephone | 239-482-2722
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN0012089
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License Number State | FL
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