Provider Demographics
NPI:1346689155
Name:CORTES, ASTRID (DMD)
Entity Type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:
Last Name:CORTES
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 1:8346 BOCA GLADES BLVD E
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4027
Mailing Address - Country:US
Mailing Address - Phone:954-821-3781
Mailing Address - Fax:
Practice Address - Street 1:4481 LAKE WORTH RD STE B
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-3929
Practice Address - Country:US
Practice Address - Phone:561-331-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-14
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN201221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice