Provider Demographics
NPI:1851043962
Name:REY LONDONO, LAURA CONSTANZA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:CONSTANZA
Last Name:REY LONDONO
Suffix:
Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:13974 SPECTOR RD APT 202
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4190
Mailing Address - Country:US
Mailing Address - Phone:415-889-9836
Mailing Address - Fax:
Practice Address - Street 1:11970 BOYETTE RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5601
Practice Address - Country:US
Practice Address - Phone:813-645-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN264651223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics