Provider Demographics
NPI:1831417005
Name:VERITAS DENTAL PA
Entity type:Organization
Organization Name:VERITAS DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRERO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-393-8121
Mailing Address - Street 1:12715 AVIANO DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-4932
Mailing Address - Country:US
Mailing Address - Phone:917-796-7624
Mailing Address - Fax:
Practice Address - Street 1:2475 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3917
Practice Address - Country:US
Practice Address - Phone:305-393-8121
Practice Address - Fax:786-431-5421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty