Provider Demographics
NPI:1356593024
Name:MARCANTONIO, CATHERINE VEGA (DMD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:VEGA
Last Name:MARCANTONIO
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 1:842 HIGHWAY 20 E STE 102
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-3902
Mailing Address - Country:US
Mailing Address - Phone:850-835-5437
Mailing Address - Fax:850-897-5797
Practice Address - Street 1:842 HIGHWAY 20 E STE 102
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:FL
Practice Address - Zip Code:32439-3902
Practice Address - Country:US
Practice Address - Phone:850-835-5437
Practice Address - Fax:850-897-5797
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN149571223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry