Provider Demographics
NPI:1801313358
Name:ALAYNA CORDEN DMD, MS, PC
Entity type:Organization
Organization Name:ALAYNA CORDEN DMD, MS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:248-910-2194
Mailing Address - Street 1:2323 N LEAVITT ST APT 201
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6805
Mailing Address - Country:US
Mailing Address - Phone:248-910-2194
Mailing Address - Fax:
Practice Address - Street 1:10258 SOUTHWEST HWY STE C
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1361
Practice Address - Country:US
Practice Address - Phone:708-576-8442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-25
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030838261QD0000X
IL319020139261QD0000X
IL021002770261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1538566328Medicaid