Provider Demographics
NPI:1023325701
Name:DANIEL DORREGO DDS PA
Entity type:Organization
Organization Name:DANIEL DORREGO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ARTURO
Authorized Official - Last Name:DORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-558-3811
Mailing Address - Street 1:1075 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4103
Mailing Address - Country:US
Mailing Address - Phone:305-558-3811
Mailing Address - Fax:305-888-4324
Practice Address - Street 1:1075 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4103
Practice Address - Country:US
Practice Address - Phone:305-558-3811
Practice Address - Fax:305-888-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0012625122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty