Provider Demographics
NPI:1982433637
Name:CORO PEDIATRIC DENTISTRY
Entity type:Organization
Organization Name:CORO PEDIATRIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-301-4477
Mailing Address - Street 1:8245 SW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5451
Mailing Address - Country:US
Mailing Address - Phone:786-301-4477
Mailing Address - Fax:
Practice Address - Street 1:8584 SW 40 STREET
Practice Address - Street 2:WEST SIDE
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:786-301-4477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty