Provider Demographics
NPI:1124115837
Name:CORPAS, ALFREDO DOMINGO JR (DDS)
Entity type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:DOMINGO
Last Name:CORPAS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18545 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6845
Mailing Address - Country:US
Mailing Address - Phone:305-259-9130
Mailing Address - Fax:305-259-9120
Practice Address - Street 1:18545 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6845
Practice Address - Country:US
Practice Address - Phone:305-259-9130
Practice Address - Fax:305-259-9120
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL076609700Medicaid