Provider Demographics
NPI:1386829927
Name:CORDER, GUADALIPE N (DDS INC)
Entity Type:Individual
Prefix:DR
First Name:GUADALIPE
Middle Name:N
Last Name:CORDER
Suffix:
Gender:F
Credentials:DDS INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 E ROUTE 66
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-3748
Mailing Address - Country:US
Mailing Address - Phone:626-914-3900
Mailing Address - Fax:626-914-0019
Practice Address - Street 1:1435 E ROUTE 66
Practice Address - Street 2:SUITE D
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3748
Practice Address - Country:US
Practice Address - Phone:626-914-3900
Practice Address - Fax:626-914-0019
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA322861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3228601Medicaid