Provider Demographics
NPI:1508142217
Name:DENTAL ASSOCIATES OF DAVIE
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF DAVIE
Other - Org Name:DR. ALFREDO D. CORPAS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:DOMINGO
Authorized Official - Last Name:CORPAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-474-2422
Mailing Address - Street 1:2879 S. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328
Mailing Address - Country:US
Mailing Address - Phone:954-474-2422
Mailing Address - Fax:954-474-1966
Practice Address - Street 1:2879 S. UNIVERSITY DR.
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-474-2422
Practice Address - Fax:954-474-1966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013451122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty