Healthcare Provider Details

I. General information

NPI: 1346322716
Provider Name (Legal Business Name): DONALD B CORK JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 LAKE ANDREW DR UNIT 102
MELBOURNE FL
32940-8763
US

IV. Provider business mailing address

5185 HEBRON DR
MERRITT ISLAND FL
32953-8157
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-3033
  • Fax:
Mailing address:
  • Phone: 712-253-8417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberM847
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN26586
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: