Basic Information
| Provider Information | |||||||||
| NPI: | 1689806077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSPINA | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | MARIA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 511 SE 5TH AVE | ||||||||
| Address2: | APT | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333012984 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542621675 | ||||||||
| FaxNumber: | 9542621793 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 S UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333282018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9542621675 | ||||||||
| FaxNumber: | 9542621782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2009 | ||||||||
| LastUpdateDate: | 10/23/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 522 | FL | N | Dental Providers | Dentist | 1223S0112X | DN20977 | FL | Y | Dental Providers | Dentist | Oral and Maxillofacial Surgery | 122300000X | DN20977 | FL | N | Dental Providers | Dentist |
No ID Information.