Provider Demographics
NPI:1336827542
Name:CARRAZANA GARCES, EDISNEL (DDS)
Entity Type:Individual
Prefix:
First Name:EDISNEL
Middle Name:
Last Name:CARRAZANA GARCES
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 1:10850 W FLAGLER ST APT D308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1463
Mailing Address - Country:US
Mailing Address - Phone:813-573-4921
Mailing Address - Fax:
Practice Address - Street 1:2706 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33322-2435
Practice Address - Country:US
Practice Address - Phone:954-741-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN283441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice