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General NPI Number Information
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NPI Number | 1225574361
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Entity Type | Organization
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Legal Business Name | CODINGTON LLC
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Dates
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Enumeration Date | 01/12/2017
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Last Update Date | 01/12/2017
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Provider Practice Location Address
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Address Line | 424 N SAN MATEO DR STE 300
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City | SAN MATEO
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State | CA
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Zip | 94401-2492
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Country | US
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Telephone | 650-772-5642
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Fax |
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Provider Business Mailing Address
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Address Line | 2112 EASTON DR
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City | BURLINGAME
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State | CA
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Zip | 94010-5636
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Country | US
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Telephone | 650-772-5642
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Fax |
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Authorized Official
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Title or Position | DDS
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Name | TERRENCE CODINGTON
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Credential |
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Telephone | 650-772-5642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 307478
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License Number State | CA
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