Provider Demographics
NPI:1750427852
Name:VERARDI DENTAL
Entity type:Organization
Organization Name:VERARDI DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:VERARDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-688-9901
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty