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General NPI Number Information
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NPI Number | 1831417005
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Entity Type | Organization
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Legal Business Name | VERITAS DENTAL PA
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Dates
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Enumeration Date | 05/12/2010
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Last Update Date | 05/12/2010
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Provider Practice Location Address
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Address Line | 2475 E 5TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-3917
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Country | US
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Telephone | 305-393-8121
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Fax | 786-431-5421
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Provider Business Mailing Address
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Address Line | 12715 AVIANO DR
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City | NAPLES
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State | FL
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Zip | 34105-4932
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Country | US
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Telephone | 917-796-7624
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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 TERRERO
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Credential | DDS
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Telephone | 305-393-8121
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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 | DN17477
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License Number State | FL
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