Individual
DIANA CORREA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
63 MAIN ST, BROCKTON, MA 02301-4042
(508) 894-3681
Mailing address
27 RANGE HEIGHTS TER, LYNN, MA 01904-1554
(786) 657-0309
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DL15216
MA
363AS0400X
Surgical Physician Assistant
17-641
FL
Other
Enumeration date
01/30/2018
Last updated
10/29/2023
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