Provider Demographics
NPI:1306110283
Name:CHARLES W KORANDO, DDS, PC
Entity type:Organization
Organization Name:CHARLES W KORANDO, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:KORANDO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-997-3111
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-0006
Mailing Address - Country:US
Mailing Address - Phone:541-997-3111
Mailing Address - Fax:541-997-7493
Practice Address - Street 1:1705 22ND ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9551
Practice Address - Country:US
Practice Address - Phone:541-997-3111
Practice Address - Fax:541-997-7493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-24
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty