Provider Demographics
NPI:1659513380
Name:BOTERO, CATALINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CATALINA
Middle Name:
Last Name:BOTERO
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 1:12950 RACE TRACK RD STE SUITE109
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-1309
Mailing Address - Country:US
Mailing Address - Phone:813-803-3355
Mailing Address - Fax:813-213-4736
Practice Address - Street 1:12950 RACE TRACK RD STE 109
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-1304
Practice Address - Country:US
Practice Address - Phone:813-803-3355
Practice Address - Fax:813-213-4736
Is Sole Proprietor?:No
Enumeration Date:2009-03-26
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN188991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice