Provider Demographics
NPI:1720158827
Name:INOCENCIO, CORAZON C (DMD)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:C
Last Name:INOCENCIO
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 1:991 MONTAGUE EXPRESSWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6819
Mailing Address - Country:US
Mailing Address - Phone:408-946-8898
Mailing Address - Fax:408-946-1814
Practice Address - Street 1:991 MONTAGUE EXPRESSWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6819
Practice Address - Country:US
Practice Address - Phone:408-946-8898
Practice Address - Fax:408-946-1814
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist