Provider Demographics
NPI:1225429038
Name:CORZO, LORENA MARIE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:MARIE
Last Name:CORZO
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 SE 2ND ST APT 104E
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5609
Mailing Address - Country:US
Mailing Address - Phone:786-395-1288
Mailing Address - Fax:
Practice Address - Street 1:14201 SW 66TH ST
Practice Address - Street 2:APT 508-A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183
Practice Address - Country:US
Practice Address - Phone:786-395-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN214661223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics