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General NPI Number Information
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NPI Number | 1477804888
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Entity Type | Organization
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Legal Business Name | VERITAS DENTAL HOLLYWOOD PA
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Dates
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Enumeration Date | 09/25/2012
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Last Update Date | 09/25/2012
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Provider Practice Location Address
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Address Line | 6517 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4008
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Country | US
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Telephone | 954-399-7839
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Fax |
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Provider Business Mailing Address
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Address Line | 6517 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4008
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Country | US
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Telephone | 954-399-7839
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN E TERRERO
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Credential | DDS
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Telephone | 945-399-7839
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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 | DN 17477
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License Number State | FL
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