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General NPI Number Information
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NPI Number | 1952035859
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Entity Type | Organization
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Legal Business Name | CORCORAN PRIVITERA FAMILY DENTAL LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 15 SHAKER RUN RD
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City | PEEBLES
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State | OH
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Zip | 45660-9401
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Country | US
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Telephone | 937-587-3903
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Fax |
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Provider Business Mailing Address
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Address Line | 415 MARKET ST
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City | PIKETON
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State | OH
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Zip | 45661-9111
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Country | US
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Telephone | 440-415-2334
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRANDON M PRIVITERA
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Credential | DDS
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Telephone | 440-415-2334
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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 |
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License Number State |
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