Individual provider Active NPI

Elsa Grullon Cortorreal, DDS

  • General Practice Dentistry
  • Miramar, FL
National Provider Identifier
1922106293
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
11432 Issued in FL
Practice address
2501 SW 101St Ave Ste 107
Miramar, FL 33025-5092
Phone
(354) 399-8025
Fax
(954) 399-8397
NPI assigned
Sep 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 11432 FL Primary

Addresses

Primary practice location

2501 SW 101St Ave Ste 107
Miramar, FL 33025-5092

Mailing address

2501 SW 101St Ave Ste 107
Miramar, FL 33025-5092
Phone (954) 399-8025

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
11432FLMDNeurological Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Dental Solutions, Inc CurrentSince Aug 17, 2025 Accepting new patients
Bella Smile Dental Inc Past Accepting new patients
Perfect Smile Dental Group, L.L.C Past Accepting new patients

Locations

2501 SW 101st Ave
Ste 107
Miramar, FL 33025
Phone (354) 399-8025

Networks

  • Freedom Health HMO Network

Organizations & group practices 3

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1922106293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 SW 101ST AVE STE 107",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330255092",
            "telephone_number": "954-399-8025",
            "fax_number": "954-399-8397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 SW 101ST AVE STE 107",
            "city": "MIRAMAR",
            "state": "FL",
            "postal_code": "330255092",
            "telephone_number": "354-399-8025",
            "fax_number": "954-399-8397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORTORREAL",
        "first_name": "ELSA",
        "middle_name": "GRULLON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "11432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miramar, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.