Healthcare Provider Details

I. General information

NPI: 1366574378
Provider Name (Legal Business Name): STEVEN G CORBETT LD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 NW 3RD AVE
CANBY OR
97013-3603
US

IV. Provider business mailing address

6799 SW ALDEN ST
PORTLAND OR
97223-1328
US

V. Phone/Fax

Practice location:
  • Phone: 503-266-1800
  • Fax:
Mailing address:
  • Phone: 503-244-7355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License NumberDT-DO-643631
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: