Provider Demographics
NPI:1669161469
Name:FINE, CORI ALAINE (DMD)
Entity type:Individual
Prefix:DR
First Name:CORI
Middle Name:ALAINE
Last Name:FINE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 PORTAFINO CT APT 101
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91766-0924
Mailing Address - Country:US
Mailing Address - Phone:845-709-5828
Mailing Address - Fax:
Practice Address - Street 1:420 PORTAFINO CT APT 101
Practice Address - Street 2:
Practice Address - City:PHILLIPS RANCH
Practice Address - State:CA
Practice Address - Zip Code:91766-0924
Practice Address - Country:US
Practice Address - Phone:845-709-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program