Provider Demographics
NPI:1134537822
Name:CORAL POINT DENTAL ASSOCIATES
Entity type:Organization
Organization Name:CORAL POINT DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:QUESADA
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:305-229-7026
Mailing Address - Street 1:8410 W FLAGLER ST
Mailing Address - Street 2:104
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-229-7026
Mailing Address - Fax:305-433-5048
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:104
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-229-7026
Practice Address - Fax:305-433-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14574261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental