Provider Demographics
NPI:1558584433
Name:HARDER, CORIE GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORIE
Middle Name:GRACE
Last Name:HARDER
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 1:8725 WOODMAN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6562
Mailing Address - Country:US
Mailing Address - Phone:818-891-6670
Mailing Address - Fax:818-893-4439
Practice Address - Street 1:8725 WOODMAN AVE STE B
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6562
Practice Address - Country:US
Practice Address - Phone:818-891-6670
Practice Address - Fax:818-893-4439
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA448891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice