Healthcare Provider Details

I. General information

NPI: 1790755205
Provider Name (Legal Business Name): MARIA ISABEL KORSNES D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3D DENTAL BATTALION/NDC 3D MLG, UNIT 38450
FPO AP
96604-8450
JP

IV. Provider business mailing address

PSC 557, BOX 3266
FPO AP
96379
JP

V. Phone/Fax

Practice location:
  • Phone: 6457381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901015167
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: