Provider Demographics
NPI:1013697069
Name:BEJARANO, VICTORIA (DMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:BEJARANO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3775 ROSCOMMON DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-2850
Mailing Address - Country:US
Mailing Address - Phone:386-492-9300
Mailing Address - Fax:
Practice Address - Street 1:3775 ROSCOMMON DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-2850
Practice Address - Country:US
Practice Address - Phone:386-492-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist