MEDICARE: DR. JAMES KILLINGER CORNICK DDS

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	1223D0001X	Public Health Dentistry	041411129	VA

General Provider Information

NPI Number	:	1619945243
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES KILLINGER CORNICK DDS

Provider Business Mailing Address
First Line	:	763 CONFUSION ACRES DR
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-2306
Country	:	US
Telephone Number	:	540-721-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 MARKET STREET
Second Line	:
City	:	NEW CASTLE
State	:	VA
Zip	:	24127
Country	:	US
Telephone Number	:	540-864-5556
Fax Number	:

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	11/18/2011

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