Provider Demographics
NPI:1477651297
Name:DORREGO, DANIEL A (DDS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:A
Last Name:DORREGO
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 1:1075 EAST 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4103
Mailing Address - Country:US
Mailing Address - Phone:305-558-3811
Mailing Address - Fax:305-888-4324
Practice Address - Street 1:1075 EAST 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4103
Practice Address - Country:US
Practice Address - Phone:305-558-3811
Practice Address - Fax:305-888-4324
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00126251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice