Provider Demographics
NPI:1093879520
Name:HALEY-CORSO, HELENE MARIE (DMD)
Entity Type:Individual
Prefix:
First Name:HELENE
Middle Name:MARIE
Last Name:HALEY-CORSO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 INTRACOASTAL DR
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33487-4209
Mailing Address - Country:US
Mailing Address - Phone:561-272-3611
Mailing Address - Fax:
Practice Address - Street 1:1590 NW 10TH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-1313
Practice Address - Country:US
Practice Address - Phone:561-395-7088
Practice Address - Fax:561-395-3482
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 127041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN 12704OtherSTATE OF FLORIDA LICENSE