Provider Demographics
NPI:1760857478
Name:BOTERO, CAROLINA (DDS)
Entity Type:Individual
Prefix:MS
First Name:CAROLINA
Middle Name:
Last Name:BOTERO
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 1:6520 NW 114TH AVE APT 1625
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4586
Mailing Address - Country:US
Mailing Address - Phone:305-934-4158
Mailing Address - Fax:
Practice Address - Street 1:6520 NW 114TH AVE APT 1625
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4586
Practice Address - Country:US
Practice Address - Phone:305-934-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21563122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist