MEDICARE: DR. PATRICK JAMES CORNING D.M.D., MS

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	1223P0300X	Periodontics	ETN377	TX
2	122300000X	Dentist	D9882	OR

General Provider Information

NPI Number	:	1063763167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICK JAMES CORNING D.M.D., MS

Provider Business Mailing Address
First Line	:	2525 NW LOVEJOY ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2861
Country	:	US
Telephone Number	:	503-222-2844
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 NW LOVEJOY ST STE 100
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-2861
Country	:	US
Telephone Number	:	503-222-2844
Fax Number	:

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

Provider Enumeration Date	:	09/28/2012
Last Update Date	:	02/22/2019

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Directions to “ DR. PATRICK JAMES CORNING D.M.D., MS” Practice Location

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