Provider Demographics
NPI:1245511013
Name:CORBRIDGE ORTHODONTICS PLLC
Entity type:Organization
Organization Name:CORBRIDGE ORTHODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:K
Authorized Official - Last Name:CORBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:916-990-4823
Mailing Address - Street 1:5110 ELDORADO PKWY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8697
Mailing Address - Country:US
Mailing Address - Phone:916-990-4823
Mailing Address - Fax:
Practice Address - Street 1:5110 ELDORADO PKWY
Practice Address - Street 2:SUITE 500
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8697
Practice Address - Country:US
Practice Address - Phone:916-990-4823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty