Individual
DR. MAURO CORREA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
4323 HILL STREET, USA DENTAL HEALTH ACTIVITY, FT JACKSON, SC 29207-6022
(803) 751-6209
Mailing address
9900 LINCOLN ST FL 2, USA DENTAL ACTIVITY, TACOMA, WA 98431-0001
(253) 968-4029
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
22DI02506700
NJ
1223E0200X
Endodontics
FC3508124
NJ
1223G0001X
General Practice Dentistry
Primary
9466
SC
Other
Enumeration date
08/20/2012
Last updated
09/23/2019
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