Provider Demographics
NPI:1760147441
Name:CORAL GABLES DENTISTRY AND PROSTHODONTICS, PA
Entity Type:Organization
Organization Name:CORAL GABLES DENTISTRY AND PROSTHODONTICS, PA
Other - Org Name:CORAL GABLES DENTISTRY AND PROSTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSORIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-567-1992
Mailing Address - Street 1:3326 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7211
Mailing Address - Country:US
Mailing Address - Phone:305-567-1992
Mailing Address - Fax:
Practice Address - Street 1:3326 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7211
Practice Address - Country:US
Practice Address - Phone:305-567-1992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-08
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty