Provider Demographics
NPI:1699006072
Name:DE VERA, VANESSA JOHANNA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:JOHANNA
Last Name:DE VERA
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 1:8520 SW 103RD ST
Mailing Address - Street 2:APARTMENT # 601
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2437
Mailing Address - Country:US
Mailing Address - Phone:786-200-8693
Mailing Address - Fax:
Practice Address - Street 1:833 NORTH HOMESTEAD BLVD
Practice Address - Street 2:APARTMENT # 601
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-3104
Practice Address - Country:US
Practice Address - Phone:305-245-3247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-25
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18847122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist