Provider Demographics
NPI:1851557383
Name:CORBO, ANTHONY GERARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GERARD
Last Name:CORBO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 KANE CONCOURSE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2053
Mailing Address - Country:US
Mailing Address - Phone:305-861-9200
Mailing Address - Fax:305-861-9211
Practice Address - Street 1:1160 KANE CONCOURSE
Practice Address - Street 2:SUITE 303
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2053
Practice Address - Country:US
Practice Address - Phone:305-861-9200
Practice Address - Fax:305-861-9211
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5458122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist