Provider Demographics
NPI:1659568848
Name:ISABEL CORREA DDS, INC.
Entity Type:Organization
Organization Name:ISABEL CORREA DDS, INC.
Other - Org Name:COMFORT DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISABEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:909-427-0707
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9161601Medicare PIN