Provider Demographics
NPI:1225574361
Name:CODINGTON LLC
Entity type:Organization
Organization Name:CODINGTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:TERRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:CODINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-772-5642
Mailing Address - Street 1:2112 EASTON DR
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5636
Mailing Address - Country:US
Mailing Address - Phone:650-772-5642
Mailing Address - Fax:
Practice Address - Street 1:424 N SAN MATEO DR STE 300
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2492
Practice Address - Country:US
Practice Address - Phone:650-772-5642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307478122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty