Provider Demographics
NPI:1306142260
Name:ANNY B. VERA D.D.S., M.SC., P.A
Entity type:Organization
Organization Name:ANNY B. VERA D.D.S., M.SC., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNY
Authorized Official - Middle Name:B
Authorized Official - Last Name:VERA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-274-2021
Mailing Address - Street 1:1667 N CLYDE MORRIS BLVD # 1
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5500
Mailing Address - Country:US
Mailing Address - Phone:386-274-2021
Mailing Address - Fax:386-274-1743
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD # 1
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5500
Practice Address - Country:US
Practice Address - Phone:386-274-2021
Practice Address - Fax:386-274-1743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6482270001OtherPTAN NUMBER