Healthcare Provider Details

I. General information

NPI: 1548124274
Provider Name (Legal Business Name): RAYVEN CHIQUITA-SIMONE NEWBERRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17021 THREE OAKS MARKETPLACE DR UNIT 101
FORT MYERS FL
33912-2587
US

IV. Provider business mailing address

12841 CYPRESS CAPE CIR UNIT 366
FORT MYERS FL
33966-1618
US

V. Phone/Fax

Practice location:
  • Phone: 239-955-8101
  • Fax: 239-955-8102
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: