Provider Demographics
NPI:1679982243
Name:AVE MARIA DENTISTRY
Entity type:Organization
Organization Name:AVE MARIA DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAITLIN
Authorized Official - Middle Name:POL
Authorized Official - Last Name:MCLAUGHLIN-RAIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-919-6930
Mailing Address - Street 1:5064 ANNUNCIATION CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:AVE MARIA
Mailing Address - State:FL
Mailing Address - Zip Code:34142-9671
Mailing Address - Country:US
Mailing Address - Phone:239-919-6930
Mailing Address - Fax:
Practice Address - Street 1:5064 ANNUNCIATION CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9671
Practice Address - Country:US
Practice Address - Phone:239-919-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18551261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental