Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN20185 | FL |
NPI | 1053707729 |
---|---|
Provider Name | Cara Lynn Wiewiora |
First Address | Longwood, FL 32779-4480 |
Second Address | Longwood, FL 32779-4480 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2015 |
Last Update Date | 22/06/2018 |