MEDICARE: DR. DAVID GERARD CORNELL D.D.S.

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	122300000X	Dentist	042138	NY

General Provider Information

NPI Number	:	1871503813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID GERARD CORNELL D.D.S.

Provider Business Mailing Address
First Line	:	98 GEORGE ST
Second Line	:
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1206
Country	:	US
Telephone Number	:	518-273-0285
Fax Number	:	518-273-0255

Provider Business Practice Location Address
First Line	:	98 GEORGE ST
Second Line	:
City	:	GREEN ISLAND
State	:	NY
Zip	:	12183-1206
Country	:	US
Telephone Number	:	518-273-0285
Fax Number	:	518-273-0255

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DAVID GERARD CORNELL D.D.S.” Practice Location

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