Provider Demographics
NPI:1184204505
Name:CORSAR DENTAL
Entity Type:Organization
Organization Name:CORSAR DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CORTIZAS SARDINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-303-6741
Mailing Address - Street 1:4355 W 16TH AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7668
Mailing Address - Country:US
Mailing Address - Phone:786-800-9507
Mailing Address - Fax:
Practice Address - Street 1:4355 W 16TH AVE STE 205A
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7668
Practice Address - Country:US
Practice Address - Phone:786-800-9507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty