Provider Demographics
NPI:1376629303
Name:CORO, RYAN ANGEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:ANGEL
Last Name:CORO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11272 N.W. 79 LANE
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178
Mailing Address - Country:US
Mailing Address - Phone:786-271-5907
Mailing Address - Fax:
Practice Address - Street 1:4980 PALM AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3726
Practice Address - Country:US
Practice Address - Phone:305-362-8089
Practice Address - Fax:305-362-4224
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16306122300000X
FLDN 16306122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist