Provider Demographics
NPI:1841737079
Name:BRITO DENTAL, LLC
Entity Type:Organization
Organization Name:BRITO DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:1787-435-3064
Mailing Address - Street 1:2070 S MILITARY TRL STE 102
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6409
Mailing Address - Country:US
Mailing Address - Phone:561-296-2032
Mailing Address - Fax:
Practice Address - Street 1:2070 S MILITARY TRL STE 102
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33415-6409
Practice Address - Country:US
Practice Address - Phone:561-296-2032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20957261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental