Provider Demographics
NPI:1083753149
Name:CORREA, MARIA-ISABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIA-ISABEL
Middle Name:
Last Name:CORREA
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 1:17171 FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-9047
Mailing Address - Country:US
Mailing Address - Phone:909-427-0707
Mailing Address - Fax:909-427-0776
Practice Address - Street 1:17171 FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-9047
Practice Address - Country:US
Practice Address - Phone:909-427-0707
Practice Address - Fax:909-427-0776
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG91616-01Medicare ID - Type Unspecified