MEDICARE: DERMODY PEDIATRIC DENTISTRY & ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184698045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMODY PEDIATRIC DENTISTRY & ORTHODONTICS

Provider Business Mailing Address
First Line	:	2000 35TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2442
Country	:	US
Telephone Number	:	772-562-5150
Fax Number	:	772-562-2711

Provider Business Practice Location Address
First Line	:	2000 35TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-2442
Country	:	US
Telephone Number	:	772-562-5150
Fax Number	:	772-562-2711

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. LOIS DERMODY
Credential	:
Telephone Number	:	772-562-5150

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/11/2025

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Directions to “DERMODY PEDIATRIC DENTISTRY & ORTHODONTICS ” Practice Location

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