Provider Demographics
NPI:1780607770
Name:VERA, KEVIN
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9861-1 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4782
Mailing Address - Country:US
Mailing Address - Phone:904-565-1800
Mailing Address - Fax:904-646-1800
Practice Address - Street 1:3245 SOUTHSIDE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-3539
Practice Address - Country:US
Practice Address - Phone:904-565-1800
Practice Address - Fax:904-646-1800
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 125681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice