Provider Demographics
NPI:1972814747
Name:CORREA, EDUARDO MONTEIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:MONTEIRO
Last Name:CORREA
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 1:3040 OASIS GRAND BLVD APT 902
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-1536
Mailing Address - Country:US
Mailing Address - Phone:353-871-6142
Mailing Address - Fax:
Practice Address - Street 1:14651 PALM BEACH BLVD STE 101
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-2331
Practice Address - Country:US
Practice Address - Phone:239-694-9993
Practice Address - Fax:239-694-9995
Is Sole Proprietor?:No
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL189801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice