Provider Demographics
NPI:1003831769
Name:CORIA, MARILETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARILETH
Middle Name:
Last Name:CORIA
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 1:22575 BARTON RD
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5203
Mailing Address - Country:US
Mailing Address - Phone:909-825-6003
Mailing Address - Fax:909-825-6005
Practice Address - Street 1:22575 BARTON RD
Practice Address - Street 2:
Practice Address - City:GRAND TERRACE
Practice Address - State:CA
Practice Address - Zip Code:92313-5203
Practice Address - Country:US
Practice Address - Phone:909-825-6003
Practice Address - Fax:909-825-6005
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA462551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice