Healthcare Provider Details

I. General information

NPI: 1861184343
Provider Name (Legal Business Name): RONALD SORIANO CORCUERA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 05/23/2023
Certification Date: 05/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 S FORT APACHE RD STE 110
LAS VEGAS NV
89148-6753
US

IV. Provider business mailing address

1991 ANTELOPE HILL CT
HENDERSON NV
89012-2183
US

V. Phone/Fax

Practice location:
  • Phone: 702-331-4444
  • Fax:
Mailing address:
  • Phone: 702-439-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7806
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7806
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: