Healthcare Provider Details

I. General information

NPI: 1649909623
Provider Name (Legal Business Name): ADAM CORIC DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 SW PINE ISLAND RD UNIT 1
CAPE CORAL FL
33991-2044
US

IV. Provider business mailing address

16030 ENCLAVES COVE DR
NORTH FORT MYERS FL
33917-3351
US

V. Phone/Fax

Practice location:
  • Phone: 239-549-0448
  • Fax:
Mailing address:
  • Phone: 248-520-5170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN27057
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: