Provider Demographics
NPI:1467853085
Name:OSPINA, CAROLINA (DMD)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:OSPINA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6747 TYRONE SQ
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-3934
Mailing Address - Country:US
Mailing Address - Phone:727-345-6100
Mailing Address - Fax:727-345-0793
Practice Address - Street 1:6747 TYRONE SQ
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3934
Practice Address - Country:US
Practice Address - Phone:727-345-6100
Practice Address - Fax:727-345-0793
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist