Healthcare Provider Details

I. General information

NPI: 1417599309
Provider Name (Legal Business Name): BRANDON ALI KORONI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 S COLUMBIA ST.
CHAPEL HILL NC
27516
US

IV. Provider business mailing address

385 S COLUMBIA ST
CHAPEL HILL NC
27516
US

V. Phone/Fax

Practice location:
  • Phone: 832-276-3783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number11522
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: