Provider Demographics
NPI:1710086491
Name:CORAL DENTAL CARE
Entity Type:Organization
Organization Name:CORAL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-344-6266
Mailing Address - Street 1:1881 N UNIVERSITY DR
Mailing Address - Street 2:STE 114
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8915
Mailing Address - Country:US
Mailing Address - Phone:954-344-6266
Mailing Address - Fax:954-344-8483
Practice Address - Street 1:1881 N UNIVERSITY DR
Practice Address - Street 2:STE 114
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8915
Practice Address - Country:US
Practice Address - Phone:954-344-6266
Practice Address - Fax:954-344-8483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00117881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty