Provider Demographics
NPI:1053547703
Name:CORO, MABEL (DDS)
Entity type:Individual
Prefix:DR
First Name:MABEL
Middle Name:
Last Name:CORO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 NE 30TH TER
Mailing Address - Street 2:STE 110
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7613
Mailing Address - Country:US
Mailing Address - Phone:305-245-0236
Mailing Address - Fax:305-245-1715
Practice Address - Street 1:925 NE 30TH TER
Practice Address - Street 2:STE 110
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7613
Practice Address - Country:US
Practice Address - Phone:305-245-0236
Practice Address - Fax:305-245-1715
Is Sole Proprietor?:No
Enumeration Date:2009-06-09
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL199571223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist