Provider Demographics
NPI:1487471835
Name:DE MAGALHAES CARVALHO, VINICIUS (DDS)
Entity type:Individual
Prefix:DR
First Name:VINICIUS
Middle Name:
Last Name:DE MAGALHAES CARVALHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 FL-44
Mailing Address - Street 2:APT. 1111
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168
Mailing Address - Country:US
Mailing Address - Phone:321-378-5108
Mailing Address - Fax:321-378-5108
Practice Address - Street 1:2102 S RIDGEWOOD AVE # 10
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:FL
Practice Address - Zip Code:32141-4240
Practice Address - Country:US
Practice Address - Phone:386-564-3086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN295571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice