MEDICARE: DR. COREY CORPODIAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	62505	CA

General Provider Information

NPI Number	:	1891121695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COREY CORPODIAN D.D.S.

Provider Business Mailing Address
First Line	:	3 CORPORATE PLAZA DR
Second Line	:	SUITE 210
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7905
Country	:	US
Telephone Number	:	949-500-6428
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 CORPORATE PLAZA DR
Second Line	:	SUITE 210
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-7905
Country	:	US
Telephone Number	:	949-500-6428
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2013
Last Update Date	:	12/19/2013

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