Provider Demographics
NPI:1851091540
Name:GARRIDO COUTIN, YENNY (DMD)
Entity Type:Individual
Prefix:
First Name:YENNY
Middle Name:
Last Name:GARRIDO COUTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4789 SW 148TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2121
Mailing Address - Country:US
Mailing Address - Phone:954-252-5911
Mailing Address - Fax:
Practice Address - Street 1:4789 SW 148TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33330-2121
Practice Address - Country:US
Practice Address - Phone:617-394-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-09
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist