MEDICARE: DR. ANTHONY R. CORRAL DMD

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	DN17063	FL

General Provider Information

NPI Number	:	1992831341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY R. CORRAL DMD

Provider Business Mailing 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	:

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/24/2025

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