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General NPI Number Information
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NPI Number | 1770654899
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Entity Type | Individual
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Provider Name | JACK H CORN D.M.D
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Gender | Male
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 80 S TUTTLE AVE
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City | SARASOTA
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State | FL
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Zip | 34237-6331
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Country | US
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Telephone | 941-924-4210
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Fax | 941-927-0563
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Provider Business Mailing Address
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Address Line | 1529 OAK WAY
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City | SARASOTA
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State | FL
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Zip | 34232-3452
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Country | US
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Telephone | 941-377-4208
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Fax | 941-371-5158
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN9100
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License Number State | FL
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