Provider Demographics
NPI:1790915635
Name:VIERA, GRETEL LETICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRETEL
Middle Name:LETICIA
Last Name:VIERA
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 1:1112 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4433
Mailing Address - Country:US
Mailing Address - Phone:727-446-8493
Mailing Address - Fax:727-443-7509
Practice Address - Street 1:1112 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4433
Practice Address - Country:US
Practice Address - Phone:727-446-8493
Practice Address - Fax:727-443-7509
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18620122300000X
FLDN 186201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice