Provider Demographics
NPI:1811053960
Name:VERA, ANTONIO (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:VERA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1895 MOWRY AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1737
Mailing Address - Country:US
Mailing Address - Phone:510-895-1470
Mailing Address - Fax:510-796-5139
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1737
Practice Address - Country:US
Practice Address - Phone:510-796-3782
Practice Address - Fax:510-796-5139
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA529531223E0200X
MA214271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics