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General NPI Number Information
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NPI Number | 1750427852
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Entity Type | Organization
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Legal Business Name | VERARDI DENTAL
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 917 RINEHART RD SUITE 2021
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City | LAKE MARY
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State | FL
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Zip | 32746-4802
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Country | US
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Telephone | 407-688-9901
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Fax | 407-688-9902
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Provider Business Mailing Address
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Address Line | 917 RINEHART RD SUITE 2021
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City | LAKE MARY
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State | FL
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Zip | 32746-4802
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Country | US
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Telephone | 407-688-9901
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Fax | 407-688-9902
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Authorized Official
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Title or Position | DOCTOR
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Name | MARY LYNN VERARDI
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Credential | D.D.S.
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Telephone | 407-688-9901
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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 | DN16615
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License Number State | FL
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