Provider Demographics
NPI:1356959399
Name:DE FREITAS, PAULA CORINNE (DDS)
Entity type:Individual
Prefix:DR
First Name:PAULA
Middle Name:CORINNE
Last Name:DE FREITAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 IVES DAIRY RD APT 306
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-5423
Mailing Address - Country:US
Mailing Address - Phone:651-432-7095
Mailing Address - Fax:
Practice Address - Street 1:1869 N 66TH AVE
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4017
Practice Address - Country:US
Practice Address - Phone:954-983-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-15
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDRPM2088390200000X
FLDN26298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program