Healthcare Provider Details

I. General information

NPI: 1992831341
Provider Name (Legal Business Name): ANTHONY R. CORRAL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 W CYPRESS CREEK RD STE 201
FORT LAUDERDALE FL
33309-1866
US

IV. Provider business mailing address

2122 W CYPRESS CREEK RD STE 201
FORT LAUDERDALE FL
33309-1866
US

V. Phone/Fax

Practice location:
  • Phone: 954-451-2290
  • Fax:
Mailing address:
  • Phone: 954-451-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN17063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: