Provider Demographics
NPI:1326156621
Name:DEA, VICTOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:DEA
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 1:1015 GATEWAY BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8347
Mailing Address - Country:US
Mailing Address - Phone:561-369-5430
Mailing Address - Fax:561-369-5431
Practice Address - Street 1:1015 GATEWAY BLVD STE 503
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8347
Practice Address - Country:US
Practice Address - Phone:561-369-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist