Provider Demographics
NPI:1689848889
Name:COLLEGE PLAZA DENTAL CENTER
Entity Type:Organization
Organization Name:COLLEGE PLAZA DENTAL CENTER
Other - Org Name:MANATEE DENTAL AT COLLEGE PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-753-5857
Mailing Address - Street 1:3633 CORTEZ RD W
Mailing Address - Street 2:SUITE A1
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3119
Mailing Address - Country:US
Mailing Address - Phone:941-753-5857
Mailing Address - Fax:941-753-6186
Practice Address - Street 1:3633 CORTEZ RD W
Practice Address - Street 2:SUITE A1
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3119
Practice Address - Country:US
Practice Address - Phone:941-753-5857
Practice Address - Fax:941-753-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13483122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty