Provider Demographics
NPI:1124238464
Name:SAVIO, CORAGENE INGRID (DDS)
Entity type:Individual
Prefix:DR
First Name:CORAGENE
Middle Name:INGRID
Last Name:SAVIO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:CORAGENE
Other - Middle Name:INGRID
Other - Last Name:SAVIO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3969 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94114-3703
Mailing Address - Country:US
Mailing Address - Phone:415-647-7077
Mailing Address - Fax:415-647-8118
Practice Address - Street 1:3969 24TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-3703
Practice Address - Country:US
Practice Address - Phone:415-647-7077
Practice Address - Fax:415-647-8118
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA217511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice