Provider Demographics
NPI:1225573066
Name:SMILE VIERA
Entity type:Organization
Organization Name:SMILE VIERA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE AND BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ASHELEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-631-9395
Mailing Address - Street 1:5455 MURRELL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-6615
Mailing Address - Country:US
Mailing Address - Phone:321-631-9395
Mailing Address - Fax:321-632-8581
Practice Address - Street 1:5455 MURRELL RD STE 108
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-6615
Practice Address - Country:US
Practice Address - Phone:321-631-9395
Practice Address - Fax:321-632-8581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty