Provider Demographics
NPI:1982091393
Name:HANDOG, CORALINDA M (DDS)
Entity Type:Individual
Prefix:
First Name:CORALINDA
Middle Name:M
Last Name:HANDOG
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 1:345 ESTUDILLO AVE #208
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4727
Mailing Address - Country:US
Mailing Address - Phone:510-483-5366
Mailing Address - Fax:510-483-3235
Practice Address - Street 1:6163 MACK ROAD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823
Practice Address - Country:US
Practice Address - Phone:916-393-3333
Practice Address - Fax:916-393-3343
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38538122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist