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General NPI Number Information
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NPI Number | 1487135570
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Entity Type | Organization
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Legal Business Name | VI COSMETIC DENTAL GROUP, LLC
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 9149 ESTATE THOMAS STE 201
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City | ST THOMAS
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State | VI
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Zip | 00802-3132
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Country | US
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Telephone | 340-777-5950
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Fax | 407-386-7222
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Provider Business Mailing Address
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Address Line | 9149 ESTATE THOMAS STE 201
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City | ST THOMAS
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State | VI
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Zip | 00802-3132
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Country | US
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Telephone | 340-777-5950
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Fax | 407-386-7222
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MISS MARISA MADURO
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Credential |
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Telephone | 340-777-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | VI
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