Provider Demographics
NPI:1932258332
Name:STAADECKER, COURY (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:COURY
Middle Name:
Last Name:STAADECKER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE
Mailing Address - Street 2:405
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7721
Mailing Address - Country:US
Mailing Address - Phone:949-640-9475
Mailing Address - Fax:949-640-2621
Practice Address - Street 1:405 ROCKEFELLER
Practice Address - Street 2:504
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-7188
Practice Address - Country:US
Practice Address - Phone:619-665-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA480251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics