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General NPI Number Information
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NPI Number | 1316563448
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Entity Type | Individual
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Provider Name | RYAN CORBELLI DDS
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Gender | Male
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 01/18/2021
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Provider Practice Location Address
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Address Line | 6489 TRANSIT RD
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City | EAST AMHERST
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State | NY
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Zip | 14051-1427
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Country | US
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Telephone | 716-626-4427
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Fax |
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Provider Business Mailing Address
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Address Line | 240 TIFFANY LN
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City | LANCASTER
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State | NY
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Zip | 14086-9202
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Country | US
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Telephone | 716-573-4734
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 061090
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License Number State | NY
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