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General NPI Number Information
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NPI Number | 1477107464
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Entity Type | Individual
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Provider Name | KATIA CONSUEGRA DMD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2019
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Last Update Date | 07/28/2019
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Provider Practice Location Address
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Address Line | 26831 S TAMIAMI TRL UNIT 48
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City | BONITA SPRINGS
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State | FL
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Zip | 34134-7828
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Country | US
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Telephone | 239-948-3200
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Fax | 239-948-3098
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Provider Business Mailing Address
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Address Line | 27174 ELAINE DR
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-6058
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Country | US
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Telephone | 239-273-5685
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 24474
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License Number State | FL
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