Healthcare Provider Details

I. General information

NPI: 1013697069
Provider Name (Legal Business Name): VICTORIA BEJARANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3775 ROSCOMMON DR
ORMOND BEACH FL
32174-2850
US

IV. Provider business mailing address

3775 ROSCOMMON DR
ORMOND BEACH FL
32174-2850
US

V. Phone/Fax

Practice location:
  • Phone: 386-492-9300
  • Fax:
Mailing address:
  • Phone: 386-492-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN28149
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: