Provider Demographics
NPI:1134896723
Name:VUKELICH, CATHERINE (DMD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:VUKELICH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:VUKELICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:10195 ATWATER BAY DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4477
Mailing Address - Country:US
Mailing Address - Phone:775-287-0956
Mailing Address - Fax:
Practice Address - Street 1:3436 S FLORIDA AVE # 100
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4765
Practice Address - Country:US
Practice Address - Phone:863-607-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-23
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26373122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty