Healthcare Provider Details

I. General information

NPI: 1154851624
Provider Name (Legal Business Name): CORINA L GUZMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11645 BISCAYNE BLVD STE 406
MIAMI FL
33181-3139
US

IV. Provider business mailing address

96 5TH AVE APT 5J
NEW YORK NY
10011-7612
US

V. Phone/Fax

Practice location:
  • Phone: 305-892-1515
  • Fax:
Mailing address:
  • Phone: 786-201-0877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN24081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: