Provider Demographics
NPI:1497848113
Name:VERGARA, RUTH MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUTH
Middle Name:MARIA
Last Name:VERGARA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 TURKEY LAKE ROAD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819
Mailing Address - Country:US
Mailing Address - Phone:407-248-0484
Mailing Address - Fax:407-248-2938
Practice Address - Street 1:6000 TURKEY LAKE ROAD
Practice Address - Street 2:SUITE 109
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819
Practice Address - Country:US
Practice Address - Phone:407-248-0484
Practice Address - Fax:407-248-2938
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice