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General NPI Number Information
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NPI Number | 1548893936
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Entity Type | Individual
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Provider Name | VANESSA MATAMOROS MENA DMD
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Gender | Female
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 1955 POINTE WEST DR
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City | VERO BEACH
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State | FL
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Zip | 32966-1302
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Country | US
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Telephone | 772-567-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 14197 SW PINNACLE CT
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City | PORT ST LUCIE
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State | FL
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Zip | 34987-6103
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Country | US
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Telephone | 772-528-3432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN25067
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License Number State | FL
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