Provider Demographics
NPI:1003824145
Name:KOREN, NATALIE (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:KOREN
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 1:3112 N.FEDERAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE PIONT
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3112 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-6738
Practice Address - Country:US
Practice Address - Phone:954-580-2200
Practice Address - Fax:954-580-2203
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 169061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice