Provider Demographics
NPI:1891121695
Name:CORPODIAN, COREY (DDS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:CORPODIAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CORPORATE PLAZA DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7905
Mailing Address - Country:US
Mailing Address - Phone:949-500-6428
Mailing Address - Fax:
Practice Address - Street 1:3 CORPORATE PLAZA DR
Practice Address - Street 2:SUITE 210
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7905
Practice Address - Country:US
Practice Address - Phone:949-500-6428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625051223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics