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General NPI Number Information
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NPI Number | 1053707729
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Entity Type | Individual
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Provider Name | CARA LYNN WIEWIORA D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/09/2015
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Last Update Date | 06/22/2018
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Provider Practice Location Address
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Address Line | 2855 W SR 434 SUITE 1011
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City | LONGWOOD
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State | FL
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Zip | 32779-4480
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Country | US
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Telephone | 407-862-1870
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Fax | 407-682-7004
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Provider Business Mailing Address
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Address Line | 2855 W SR 434 SUITE 1011
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City | LONGWOOD
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State | FL
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Zip | 32779-4480
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Country | US
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Telephone | 407-862-1870
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Fax | 407-682-7004
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN20185
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License Number State | FL
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