Provider Demographics
NPI:1760675532
Name:CORLEY, REA (DDS)
Entity Type:Individual
Prefix:DR
First Name:REA
Middle Name:
Last Name:CORLEY
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 1:7433 HERSCHEL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5175
Mailing Address - Country:US
Mailing Address - Phone:858-459-1600
Mailing Address - Fax:
Practice Address - Street 1:7433 HERSCHEL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5175
Practice Address - Country:US
Practice Address - Phone:858-459-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist