Provider Demographics
NPI:1639206469
Name:CORALINDA M HANDOG DMD INC
Entity Type:Organization
Organization Name:CORALINDA M HANDOG DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CORALINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANDOG
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:510-483-5366
Mailing Address - Street 1:345 ESTUDILLO AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577
Mailing Address - Country:US
Mailing Address - Phone:510-483-5366
Mailing Address - Fax:510-483-3235
Practice Address - Street 1:345 ESTUDILLO AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577
Practice Address - Country:US
Practice Address - Phone:510-483-5366
Practice Address - Fax:510-483-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty