Healthcare Provider Details

I. General information

NPI: 1659075497
Provider Name (Legal Business Name): LAURA GABRIELA WORD RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA GABRIELA VASQUEZ SIFONTES MAIDEN NAME

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 13TH ST
SAINT CLOUD FL
34769-6722
US

IV. Provider business mailing address

6965 BIG BEND DR
SAINT CLOUD FL
34771-7324
US

V. Phone/Fax

Practice location:
  • Phone: 407-707-6564
  • Fax:
Mailing address:
  • Phone: 407-818-8212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32261
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH27506
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: