MEDICARE: RFD1 PLLC

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

General Provider Information

NPI Number	:	1407706468
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RFD1 PLLC

Provider Business Mailing Address
First Line	:	1475 BEACH AVE
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-5733
Country	:	US
Telephone Number	:	904-472-7277
Fax Number	:

Provider Business Practice Location Address
First Line	:	2122 W CYPRESS CREEK RD STE 201
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1866
Country	:	US
Telephone Number	:	954-451-2290
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY R CORRAL
Credential	:	DMD
Telephone Number	:	904-472-7277

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	02/06/2026

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