Provider Demographics
NPI:1275632622
Name:VEVERA, KEITH LAWRENCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LAWRENCE
Last Name:VEVERA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7602 W SAND LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5112
Mailing Address - Country:US
Mailing Address - Phone:407-826-1234
Mailing Address - Fax:407-826-1234
Practice Address - Street 1:7602 W SAND LAKE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5112
Practice Address - Country:US
Practice Address - Phone:407-826-1234
Practice Address - Fax:407-826-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL137621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56776OtherBCBS
FL836728OtherUNITED CONCORDIA