Provider Demographics
NPI:1255176855
Name:RUSSELL DA CUNHA COELHO, ALESSANDRA
Entity type:Individual
Prefix:
First Name:ALESSANDRA
Middle Name:
Last Name:RUSSELL DA CUNHA COELHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7420 NW 5TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1611
Mailing Address - Country:US
Mailing Address - Phone:954-859-5538
Mailing Address - Fax:954-859-5930
Practice Address - Street 1:7420 NW 5TH ST STE 104
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1611
Practice Address - Country:US
Practice Address - Phone:954-859-5538
Practice Address - Fax:954-859-5930
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist