Provider Demographics
NPI:1710101621
Name:VIERA, YERITXA ENID (DMD)
Entity Type:Individual
Prefix:DR
First Name:YERITXA
Middle Name:ENID
Last Name:VIERA
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 1:2905 LEGION LAKE RD
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-2984
Mailing Address - Country:US
Mailing Address - Phone:939-717-5599
Mailing Address - Fax:
Practice Address - Street 1:9579 GA-5 SUITE 701
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-3013
Practice Address - Country:US
Practice Address - Phone:770-746-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2739122300000X
SC4502122300000X
TX258771223P0300X
GADN0136151223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist