MEDICARE: DR. RYAN ANGEL CORO 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	122300000X	Dentist	DN16306	FL
2	122300000X	Dentist	DN 16306	FL

General Provider Information

NPI Number	:	1376629303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN ANGEL CORO D.D.S.

Provider Business Mailing Address
First Line	:	11272 N.W. 79 LANE
Second Line	:
City	:	MEDLEY
State	:	FL
Zip	:	33178
Country	:	US
Telephone Number	:	786-271-5907
Fax Number	:

Provider Business Practice Location Address
First Line	:	4980 PALM AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-3726
Country	:	US
Telephone Number	:	305-362-8089
Fax Number	:	305-362-4224

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	03/17/2018

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