Provider Demographics
NPI:1093710436
Name:CORONA, DENNIS A (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:A
Last Name:CORONA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 CORTEZ RD W
Mailing Address - Street 2:STE A01
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3100
Mailing Address - Country:US
Mailing Address - Phone:941-753-5857
Mailing Address - Fax:941-753-6186
Practice Address - Street 1:3633 CORTEZ RD W
Practice Address - Street 2:STE A01
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3100
Practice Address - Country:US
Practice Address - Phone:941-753-5857
Practice Address - Fax:941-753-6186
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL134831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice