Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN14430 | FL |
NPI | 1063482594 |
---|---|
Provider Name | Christopher Mark Dermody |
First Address | Vero Beach, FL 32960 |
Second Address | Vero Beach, FL 32960 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 08/07/2007 |