Provider Demographics
NPI:1689806077
Name:OSPINA, ANA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANA
Middle Name:MARIA
Last Name:OSPINA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 SE 5TH AVE
Mailing Address - Street 2:APT
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-2984
Mailing Address - Country:US
Mailing Address - Phone:954-262-1675
Mailing Address - Fax:954-262-1793
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1675
Practice Address - Fax:954-262-1782
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL522122300000X
FLDN209771223S0112X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist