Healthcare Provider Details

I. General information

NPI: 1619975117
Provider Name (Legal Business Name): JARROD CRAIG CORNEHL D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 TROUBADOUR ST
WEST PALM BEACH FL
33406-3607
US

IV. Provider business mailing address

2800 TROUBADOUR ST
WEST PALM BEACH FL
33406-3607
US

V. Phone/Fax

Practice location:
  • Phone: 415-746-0746
  • Fax:
Mailing address:
  • Phone: 415-746-0746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52365
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN28948
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20982
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: