MEDICARE: DR. CATHERINE VEGA MARCANTONIO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0221X	Pediatric Dentistry	DN14957	FL

General Provider Information

NPI Number	:	1356593024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE VEGA MARCANTONIO DMD

Provider Business Mailing Address
First Line	:	842 HIGHWAY 20 E STE 102
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-3902
Country	:	US
Telephone Number	:	850-835-5437
Fax Number	:	850-897-5797

Provider Business Practice Location Address
First Line	:	842 HIGHWAY 20 E STE 102
Second Line	:
City	:	FREEPORT
State	:	FL
Zip	:	32439-3902
Country	:	US
Telephone Number	:	850-835-5437
Fax Number	:	850-897-5797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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