Healthcare Provider Details

I. General information

NPI: 1649847815
Provider Name (Legal Business Name): LAURA ALEJANDRA VERGARA CAMPERO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6839 COLLIER BLVD STE 103
NAPLES FL
34114-3632
US

IV. Provider business mailing address

5871 GREEN BLVD
NAPLES FL
34116-4946
US

V. Phone/Fax

Practice location:
  • Phone: 239-206-1659
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN25847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: