Provider Demographics
NPI:1487135570
Name:VI COSMETIC DENTAL GROUP, LLC
Entity type:Organization
Organization Name:VI COSMETIC DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADURO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:340-777-5950
Mailing Address - Street 1:9149 ESTATE THOMAS STE 201
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3132
Mailing Address - Country:US
Mailing Address - Phone:340-777-5950
Mailing Address - Fax:407-386-7222
Practice Address - Street 1:9149 ESTATE THOMAS STE 201
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3132
Practice Address - Country:US
Practice Address - Phone:340-777-5950
Practice Address - Fax:407-386-7222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty