Provider Demographics
NPI:1518491133
Name:CARA L WIEWIORA DMD MSD PA
Entity Type:Organization
Organization Name:CARA L WIEWIORA DMD MSD PA
Other - Org Name:CENTRAL FLORIDA SMILES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIEWIORA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MSD
Authorized Official - Phone:407-862-1870
Mailing Address - Street 1:2855 W SR 434
Mailing Address - Street 2:SUITE 1011
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4480
Mailing Address - Country:US
Mailing Address - Phone:407-862-1870
Mailing Address - Fax:
Practice Address - Street 1:2855 W SR 434
Practice Address - Street 2:SUITE 1011
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-4480
Practice Address - Country:US
Practice Address - Phone:407-862-1870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20185305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service