Provider Demographics
NPI:1487889572
Name:VERO BEACH SURGICAL ARTS P.A.
Entity type:Organization
Organization Name:VERO BEACH SURGICAL ARTS P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:COLGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:772-770-9191
Mailing Address - Street 1:P.O. BOX 162906
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33116-2906
Mailing Address - Country:US
Mailing Address - Phone:772-770-9191
Mailing Address - Fax:772-770-4161
Practice Address - Street 1:1000 37TH PL STE 103
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6579
Practice Address - Country:US
Practice Address - Phone:772-770-9191
Practice Address - Fax:772-770-4161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U98057Medicare UPIN
85369YMedicare PIN