Healthcare Provider Details

I. General information

NPI: 1427158153
Provider Name (Legal Business Name): EVE CORNELL MD, DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 SUGAR BEET CIR
LONGMONT CO
80501-8823
US

IV. Provider business mailing address

123 SUGAR BEET CIR
LONGMONT CO
80501-8823
US

V. Phone/Fax

Practice location:
  • Phone: 303-938-1161
  • Fax: 303-539-9875
Mailing address:
  • Phone: 303-938-1161
  • Fax: 303-539-9875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30020765
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8312
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number39080
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number39080
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: