Healthcare Provider Details

I. General information

NPI: 1144656232
Provider Name (Legal Business Name): ANDREW J CORSARO DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR # D9-6
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

1395 CENTER DR # D9-6
GAINESVILLE FL
32610-3006
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5850
  • Fax:
Mailing address:
  • Phone: 352-273-5850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: