Provider Demographics
NPI:1659075497
Name:WORD, LAURA GABRIELA (RDH)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GABRIELA
Last Name:WORD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:GABRIELA
Other - Last Name:VASQUEZ SIFONTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:6965 BIG BEND DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-7324
Mailing Address - Country:US
Mailing Address - Phone:407-818-8212
Mailing Address - Fax:
Practice Address - Street 1:7031 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4701
Practice Address - Country:US
Practice Address - Phone:052-847-7613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH27506124Q00000X
FLDRPM2690390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No124Q00000XDental ProvidersDental Hygienist