Provider Demographics
NPI:1013778992
Name:GERIGUIS, CODRINA ALEXANDRA BASTON (DDS)
Entity type:Individual
Prefix:
First Name:CODRINA
Middle Name:ALEXANDRA BASTON
Last Name:GERIGUIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9304 MOSS PRESERVE PKWY APT 306
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-6726
Mailing Address - Country:US
Mailing Address - Phone:760-805-4588
Mailing Address - Fax:
Practice Address - Street 1:2670 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3176
Practice Address - Country:US
Practice Address - Phone:321-267-1526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice