Provider Demographics
NPI:1285867531
Name:POWERS, VERONICA MM (DMD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:MM
Last Name:POWERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 BEACH 130TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLE HARBOR
Mailing Address - State:NY
Mailing Address - Zip Code:11694-1626
Mailing Address - Country:US
Mailing Address - Phone:503-577-0518
Mailing Address - Fax:
Practice Address - Street 1:222 BEACH 130TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1626
Practice Address - Country:US
Practice Address - Phone:503-577-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-02
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD93491223G0001X
NY0558791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice