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General NPI Number Information
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NPI Number | 1649535865
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Entity Type | Organization
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Legal Business Name | DENIS S. CORRAL, D.D.S., P.C.
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 11901 BUSINESS BLVD., #201
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7701
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Country | US
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Telephone | 907-694-6640
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Fax | 907-694-6681
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Provider Business Mailing Address
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Address Line | 11901 BUSINESS BLVD., #201
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7701
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Country | US
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Telephone | 907-694-6640
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Fax | 907-694-6681
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | DR. DENIS S. CORRAL
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Credential |
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Telephone | 907-694-6640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | AA552
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License Number State | AK
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