Provider Demographics
NPI:1225147911
Name:CORREA CARRO, DESIREE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:M
Last Name:CORREA CARRO
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:PO BOX 373068
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737-3068
Mailing Address - Country:US
Mailing Address - Phone:787-263-1313
Mailing Address - Fax:787-263-4597
Practice Address - Street 1:58 CALLE JOSE CELSO BARBOSA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4727
Practice Address - Country:US
Practice Address - Phone:787-263-1313
Practice Address - Fax:787-263-4597
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist