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General NPI Number Information
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NPI Number | 1710101621
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Entity Type | Individual
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Provider Name | YERITXA ENID VIERA DMD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 9579 GA-5 SUITE 701
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-3013
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Country | US
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Telephone | 770-746-8161
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Fax |
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Provider Business Mailing Address
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Address Line | 2905 LEGION LAKE RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-2984
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Country | US
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Telephone | 939-717-5599
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2739
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4502
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 25877
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | DN013615
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License Number State | GA
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