Provider Demographics
NPI:1487348173
Name:CORCHO NODARSE, LAUREN (DMD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CORCHO NODARSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10273 NW 80TH CT APT 102
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33016-2251
Mailing Address - Country:US
Mailing Address - Phone:786-241-6516
Mailing Address - Fax:
Practice Address - Street 1:10273 NW 80TH CT APT 102
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33016-2251
Practice Address - Country:US
Practice Address - Phone:786-241-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL279141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice