Healthcare Provider Details

I. General information

NPI: 1447374830
Provider Name (Legal Business Name): DAVID J KORNSTEIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 STONEHENGE DR SUITE 102
RALEIGH NC
27613-1620
US

IV. Provider business mailing address

7200 STONEHENGE DRIVE SUITE 102
RALEIGH NC
27613
US

V. Phone/Fax

Practice location:
  • Phone: 919-848-3588
  • Fax:
Mailing address:
  • Phone: 919-848-3588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7712
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: