MEDICARE: MRS. CATHERINE WIECHECKI VERGARA D.D.S.

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	122300000X	Dentist	DN15077	FL
2	122300000X	Dentist	19449	TX

General Provider Information

NPI Number	:	1386728558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CATHERINE WIECHECKI VERGARA D.D.S.

Provider Business Mailing Address
First Line	:	150 E COLUMBIA LN
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-4606
Country	:	US
Telephone Number	:	321-784-4794
Fax Number	:	321-783-0747

Provider Business Practice Location Address
First Line	:	150 E COLUMBIA LN
Second Line	:
City	:	COCOA BEACH
State	:	FL
Zip	:	32931-4606
Country	:	US
Telephone Number	:	321-784-4794
Fax Number	:	321-783-0747

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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