Healthcare Provider Details

I. General information

NPI: 1740999895
Provider Name (Legal Business Name): COREY CORPODIAN DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/21/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27620 MARGUERITE PKWY STE D
MISSION VIEJO CA
92692-3607
US

IV. Provider business mailing address

27620 MARGUERITE PKWY STE D
MISSION VIEJO CA
92692-3607
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-6633
  • Fax:
Mailing address:
  • Phone: 949-364-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. COREY CORPODIAN
Title or Position: OWNER
Credential: DDS
Phone: 949-364-6633