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General NPI Number Information
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NPI Number | 1518491133
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Entity Type | Organization
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Legal Business Name | CARA L WIEWIORA DMD MSD PA
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Dates
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Enumeration Date | 04/20/2017
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Last Update Date | 04/20/2017
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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 |
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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 |
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Authorized Official
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Title or Position | OWNER
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Name | CARA L WIEWIORA
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Credential | DMD MSD
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Telephone | 407-862-1870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | DN20185
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License Number State | FL
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