Provider Demographics
NPI:1124802343
Name:DORRA, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:DORRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20301 W COUNTRY CLUB DR APT 1822
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1657
Mailing Address - Country:US
Mailing Address - Phone:786-587-9988
Mailing Address - Fax:
Practice Address - Street 1:7975 NW 154TH ST STE 250
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5806
Practice Address - Country:US
Practice Address - Phone:305-615-6300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist