Healthcare Provider Details

I. General information

NPI: 1912995044
Provider Name (Legal Business Name): WILLIAM C CORCORAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 W DODGE RD
OMAHA NE
68114-3343
US

IV. Provider business mailing address

9202 W DODGE RD
OMAHA NE
68114-3318
US

V. Phone/Fax

Practice location:
  • Phone: 402-397-3636
  • Fax:
Mailing address:
  • Phone: 402-397-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4213
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: