Provider Demographics
NPI:1396394664
Name:VDCCR,P.A.
Entity Type:Organization
Organization Name:VDCCR,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-684-1274
Mailing Address - Street 1:7425 SPRING HILL DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-4348
Mailing Address - Country:US
Mailing Address - Phone:352-684-1274
Mailing Address - Fax:352-263-2756
Practice Address - Street 1:6824 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7806
Practice Address - Country:US
Practice Address - Phone:352-794-6139
Practice Address - Fax:352-263-2756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty