=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952822546
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAMILA NORIEGA ABREU DMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2017
-----------------------------------------------------
Last Update Date | 05/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3443 TAMIAMI TRL STE F
-----------------------------------------------------
City | PORT CHARLOTTE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33952-8159
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-629-8187
-----------------------------------------------------
Fax | 941-629-2498
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1636 BURGOS DR
-----------------------------------------------------
City | SARASOTA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34238-2713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-910-1382
-----------------------------------------------------
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 | DN22839
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------