Provider Demographics
NPI:1194577783
Name:CEREJIDO MARQUEZ, LORAINE DE LAS MERCEDES (DMD)
Entity type:Individual
Prefix:
First Name:LORAINE
Middle Name:DE LAS MERCEDES
Last Name:CEREJIDO MARQUEZ
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:LORAINE
Other - Middle Name:DE LAS MERCEDES
Other - Last Name:CEREJIDO MARQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1616 CAPE CORAL PKWY W STE 115
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6973
Mailing Address - Country:US
Mailing Address - Phone:239-256-1414
Mailing Address - Fax:
Practice Address - Street 1:1616 CAPE CORAL PKWY W STE 115
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6973
Practice Address - Country:US
Practice Address - Phone:239-256-1414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG8-CH000151223D0001X
FLDN289611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health