Provider Demographics
NPI:1316510431
Name:CORREDOR MARQUEZ, BRIGITTE GABRIELLE
Entity type:Individual
Prefix:DR
First Name:BRIGITTE
Middle Name:GABRIELLE
Last Name:CORREDOR MARQUEZ
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 1:163 N SHORE DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3926
Mailing Address - Country:US
Mailing Address - Phone:786-781-3464
Mailing Address - Fax:
Practice Address - Street 1:15400 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4614
Practice Address - Country:US
Practice Address - Phone:786-916-6937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2630001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice