MEDICARE: DR. DENNIS A CORONA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	13483	FL

General Provider Information

NPI Number	:	1093710436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DENNIS A CORONA D.D.S.

Provider Business Mailing Address
First Line	:	3633 CORTEZ RD W
Second Line	:	STE A01
City	:	BRADENTON
State	:	FL
Zip	:	34210-3100
Country	:	US
Telephone Number	:	941-753-5857
Fax Number	:	941-753-6186

Provider Business Practice Location Address
First Line	:	3633 CORTEZ RD W
Second Line	:	STE A01
City	:	BRADENTON
State	:	FL
Zip	:	34210-3100
Country	:	US
Telephone Number	:	941-753-5857
Fax Number	:	941-753-6186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	11/28/2011

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