Healthcare Provider Details

I. General information

NPI: 1760838577
Provider Name (Legal Business Name): ERICA LEAN SANTOS QUEIROZ-HEWITT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2063 ALOMA AVE STE 203
WINTER PARK FL
32792-3319
US

IV. Provider business mailing address

2063 ALOMA AVE
WINTER PARK FL
32792-3319
US

V. Phone/Fax

Practice location:
  • Phone: 407-673-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN22864
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: