Organization
DEPARTMENT OF VETERANS AFFAIRS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA GORMAN (LEAD DENTIST)
(321) 637-3646
Entity
Organization
Contact information
Practice address
2900 VETERANS WAY, MELBOURNE, FL 32940-8007
(321) 637-3646
Mailing address
2900 VETERANS WAY, MELBOURNE, FL 32940-8007
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DH 17979
FL
Other
Enumeration date
08/27/2007
Last updated
08/27/2007
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