Healthcare Provider Details

I. General information

NPI: 1649535865
Provider Name (Legal Business Name): DENIS S. CORRAL, D.D.S., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 BUSINESS BLVD., #201
EAGLE RIVER AK
99577-7701
US

IV. Provider business mailing address

11901 BUSINESS BLVD., #201
EAGLE RIVER AK
99577-7701
US

V. Phone/Fax

Practice location:
  • Phone: 907-694-6640
  • Fax: 907-694-6681
Mailing address:
  • Phone: 907-694-6640
  • Fax: 907-694-6681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberAA552
License Number StateAK

VIII. Authorized Official

Name: DR. DENIS S. CORRAL
Title or Position: PRESIDENT / OWNER
Credential:
Phone: 907-694-6640