Healthcare Provider Details

I. General information

NPI: 1881033926
Provider Name (Legal Business Name): FRANK A. CORNELLA DDS, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 E SUNSHINE ST STE B
SPRINGFIELD MO
65804-6919
US

IV. Provider business mailing address

3237 E SUNSHINE ST STE B
SPRINGFIELD MO
65804-6919
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-4546
  • Fax: 417-883-0443
Mailing address:
  • Phone: 417-881-4546
  • Fax: 417-883-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. FRANK A CORNELLA
Title or Position: OWNER
Credential: DDS,MD
Phone: 417-881-4546