=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548124274
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAYVEN CHIQUITA-SIMONE NEWBERRY DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2025
-----------------------------------------------------
Last Update Date | 12/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17021 THREE OAKS MARKETPLACE DR UNIT 101
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33912-2587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-955-8101
-----------------------------------------------------
Fax | 239-955-8102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12841 CYPRESS CAPE CIR UNIT 366
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33966-1618
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN31198
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------