Provider Demographics
NPI:1962930883
Name:CORREDOR, ANGELICA CRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:CRISTINA
Last Name:CORREDOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12970 SW 30TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5311
Mailing Address - Country:US
Mailing Address - Phone:954-391-3805
Mailing Address - Fax:
Practice Address - Street 1:12970 SW 30TH CT
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-5311
Practice Address - Country:US
Practice Address - Phone:954-391-3805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice