Provider Demographics
NPI:1982117784
Name:KASSOFF-CORREIA, BERYL SUE (CRDH)
Entity Type:Individual
Prefix:MS
First Name:BERYL
Middle Name:SUE
Last Name:KASSOFF-CORREIA
Suffix:
Gender:F
Credentials:CRDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 CLINT MOORE RD STE 138
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2801
Mailing Address - Country:US
Mailing Address - Phone:561-804-5600
Mailing Address - Fax:
Practice Address - Street 1:920 CLINT MOORE RD STE 138
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2801
Practice Address - Country:US
Practice Address - Phone:561-804-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH22926124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist