Provider Demographics
NPI:1386728558
Name:WIECHECKI VERGARA, CATHERINE (DDS)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:WIECHECKI VERGARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:VERGARA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:150 E COLUMBIA LN
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-4606
Mailing Address - Country:US
Mailing Address - Phone:321-784-4794
Mailing Address - Fax:321-783-0747
Practice Address - Street 1:150 E COLUMBIA LN
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-4606
Practice Address - Country:US
Practice Address - Phone:321-784-4794
Practice Address - Fax:321-783-0747
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15077122300000X
TX19449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist