Provider Demographics
NPI:1265680706
Name:VERA, ANNY B (DDS, MSC,PA)
Entity Type:Individual
Prefix:DR
First Name:ANNY
Middle Name:B
Last Name:VERA
Suffix:
Gender:F
Credentials:DDS, MSC,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1667 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 1
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:
Practice Address - Street 1:1667 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 1
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:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-08
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN150751223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6482270001Medicare NSC