Provider Demographics
NPI:1619114428
Name:ANDAL, CORINTHIA MORALES (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORINTHIA
Middle Name:MORALES
Last Name:ANDAL
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 1:150 S GLENDORA AVE
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3038
Mailing Address - Country:US
Mailing Address - Phone:626-919-2322
Mailing Address - Fax:626-919-2333
Practice Address - Street 1:150 S GLENDORA AVE
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3038
Practice Address - Country:US
Practice Address - Phone:626-919-2322
Practice Address - Fax:626-919-2333
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist