Provider Demographics
NPI:1881803393
Name:CORONADO, NARDA J (DDS)
Entity type:Individual
Prefix:DR
First Name:NARDA
Middle Name:J
Last Name:CORONADO
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 1:454 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4106
Mailing Address - Country:US
Mailing Address - Phone:630-896-6175
Mailing Address - Fax:630-896-7485
Practice Address - Street 1:454 N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4106
Practice Address - Country:US
Practice Address - Phone:630-896-6175
Practice Address - Fax:630-896-7485
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist