Provider Demographics
NPI:1578305827
Name:CORREA, MARISABEL CRISTINA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARISABEL
Middle Name:CRISTINA
Last Name:CORREA
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 1:3724 OAK RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3700
Mailing Address - Country:US
Mailing Address - Phone:954-661-8622
Mailing Address - Fax:
Practice Address - Street 1:3724 OAK RIDGE LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3700
Practice Address - Country:US
Practice Address - Phone:954-661-8622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist