Provider Demographics
NPI:1568814747
Name:CORUGEDO, ADA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:
Last Name:CORUGEDO
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 1:6080 SW 40TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5233
Mailing Address - Country:US
Mailing Address - Phone:305-794-8266
Mailing Address - Fax:
Practice Address - Street 1:6080 SW 40TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5233
Practice Address - Country:US
Practice Address - Phone:305-794-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist