MEDICARE: DR. WILLIAM C CORCORAN D.D.S., M.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	1223E0200X	Endodontics	4213	NE

General Provider Information

NPI Number	:	1912995044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C CORCORAN D.D.S., M.S.

Provider Business Mailing Address
First Line	:	9202 W DODGE RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3318
Country	:	US
Telephone Number	:	402-397-3636
Fax Number	:

Provider Business Practice Location Address
First Line	:	9202 W DODGE RD
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3343
Country	:	US
Telephone Number	:	402-397-3636
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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