Provider Demographics
NPI:1588193155
Name:NORENA-OTERO, DEISY ANDREA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEISY
Middle Name:ANDREA
Last Name:NORENA-OTERO
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 1:140 LAKEVIEW DR APT 103
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2517
Mailing Address - Country:US
Mailing Address - Phone:954-261-9223
Mailing Address - Fax:
Practice Address - Street 1:2500 E COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4124
Practice Address - Country:US
Practice Address - Phone:954-990-6278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN226801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice