Active NPI
Deborah Jill Corliss, DMD
- Dentist
- Pembroke Pines, FL
National Provider Identifier
1306069695
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN14403
- Practice address
- 18217 Pines Blvd
Pembroke Pines, FL 33029-1417 - Phone
- (954) 704-0506
- Fax
- (954) 441-7616
- NPI assigned
- Apr 11, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN14403 | FL | Primary |
Addresses
Primary practice location
18217 Pines Blvd
Pembroke Pines, FL 33029-1417
Mailing address
11029 Blackhawk Blvd
Davie, FL 33328-2109
Phone (954) 476-7506
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DN14403 | Other | FL | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14403 | FL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Isarelys Lazo Quintana DMD, PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Pembroke Pines, FL
- NPI 1134014087
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306069695",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11029 BLACKHAWK BLVD",
"city": "DAVIE",
"state": "FL",
"postal_code": "333282109",
"telephone_number": "954-476-7506",
"fax_number": "954-441-7616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18217 PINES BLVD",
"city": "PEMBROKE PINES",
"state": "FL",
"postal_code": "330291417",
"telephone_number": "954-704-0506",
"fax_number": "954-441-7616"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORLISS",
"first_name": "DEBORAH",
"middle_name": "JILL",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN14403",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "DN14403",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pembroke Pines, FL
- Corehealth Pharmacy Inc
- Corehealth Pharmacy Inc
- Corinthians Primary Care and Wellness LLC
- Elisabeth Anne-Marie Coriolan
- Stephanie Marie-Louise Coriolan, MD
- Cornerstone of Change, LLC
- Altagracita Cornet, NURSE PRACTITIONER
- Carmen Rosa Cornide, PSY. D.
- Dianelis Corral Lobaina
- Maysel Correa Bickham, P.A
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.