Provider Demographics
NPI:1871984591
Name:VERO DENTAL LLC
Entity type:Organization
Organization Name:VERO DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFRESNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-778-5550
Mailing Address - Street 1:3036 20TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-3004
Mailing Address - Country:US
Mailing Address - Phone:772-778-5550
Mailing Address - Fax:772-778-7944
Practice Address - Street 1:3036 20TH ST
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-3004
Practice Address - Country:US
Practice Address - Phone:772-778-5550
Practice Address - Fax:772-778-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN5535122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty