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General NPI Number Information
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NPI Number | 1750445334
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Entity Type | Organization
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Legal Business Name | BARRY F CORSO DMD PA
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1590 NW 10TH AVE SUITE 403
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City | BOCA RATON
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State | FL
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Zip | 33486-1313
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Country | US
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Telephone | 561-395-7088
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Fax | 561-395-3482
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Provider Business Mailing Address
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Address Line | 4229 INTRACOASTAL DR
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City | HIGHLAND BEACH
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State | FL
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Zip | 33487-4209
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Country | US
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Telephone | 561-272-3611
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BARRY F CORSO
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Credential | DMD
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Telephone | 561-395-7088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN12672
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License Number State | FL
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