Provider Demographics
NPI:1053707729
Name:WIEWIORA, CARA LYNN (DMD)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:LYNN
Last Name:WIEWIORA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CARA
Other - Middle Name:LYNN
Other - Last Name:WELDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
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:407-682-7004
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:407-682-7004
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201851223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics