Provider Demographics
NPI:1417903485
Name:VERARDI, MARY LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:LYNN
Last Name:VERARDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 RINEHART RD
Mailing Address - Street 2:SUITE 2021
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4802
Mailing Address - Country:US
Mailing Address - Phone:407-688-9901
Mailing Address - Fax:407-688-9902
Practice Address - Street 1:917 RINEHART RD
Practice Address - Street 2:SUITE 2021
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4802
Practice Address - Country:US
Practice Address - Phone:407-688-9901
Practice Address - Fax:407-688-9902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL166151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice