Provider Demographics
NPI:1649909623
Name:CORIC, ADAM (DMD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CORIC
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16030 ENCLAVES COVE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33917-3351
Mailing Address - Country:US
Mailing Address - Phone:248-520-5170
Mailing Address - Fax:
Practice Address - Street 1:305 SW PINE ISLAND RD UNIT 1
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2044
Practice Address - Country:US
Practice Address - Phone:239-549-0448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLDN270571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program