MEDICARE: DR. JOSHUA MICHAEL CORCRAN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	36719	TX

General Provider Information

NPI Number	:	1003421157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA MICHAEL CORCRAN DMD

Provider Business Mailing Address
First Line	:	5840 RUNNING HORSE DR
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89081-8006
Country	:	US
Telephone Number	:	702-686-8025
Fax Number	:

Provider Business Practice Location Address
First Line	:	4833 S HULEN ST STE 101
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1427
Country	:	US
Telephone Number	:	817-294-4600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2020
Last Update Date	:	09/14/2020

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