Healthcare Provider Details

I. General information

NPI: 1255508529
Provider Name (Legal Business Name): JORGE DONOSO,DDS,MS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2127 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6134
US

IV. Provider business mailing address

2127 N UNIVERSITY DR
CORAL SPRINGS FL
33071-6134
US

V. Phone/Fax

Practice location:
  • Phone: 954-341-1040
  • Fax:
Mailing address:
  • Phone: 954-341-1040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11580
License Number StateFL

VIII. Authorized Official

Name: JORGE DONOSO
Title or Position: PRESIDENT
Credential:
Phone: 954-341-1040