Provider Demographics
NPI:1366730384
Name:REVOREDO, KARIM ROSSINA (DDS)
Entity type:Individual
Prefix:DR
First Name:KARIM
Middle Name:ROSSINA
Last Name:REVOREDO
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 1:1215 ASTURIA AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4735
Mailing Address - Country:US
Mailing Address - Phone:786-238-7359
Mailing Address - Fax:
Practice Address - Street 1:1878 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-262-9299
Practice Address - Fax:305-262-8772
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN20428122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist