MEDICARE: KEVIN DANIEL VERRRETT DDS

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	122300000X	Dentist	2891-95	MS

General Provider Information

NPI Number	:	1417061508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN DANIEL VERRRETT DDS

Provider Business Mailing Address
First Line	:	1708 EAST PASS ROAD
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507
Country	:	US
Telephone Number	:	228-822-9190
Fax Number	:	228-822-9559

Provider Business Practice Location Address
First Line	:	1708 EAST PASS ROAD
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507
Country	:	US
Telephone Number	:	228-822-9190
Fax Number	:	228-822-9559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	09/25/2008

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