MEDICARE: DR. R. WILLIAM 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	1223D0001X	Public Health Dentistry	DTC105	FL

General Provider Information

NPI Number	:	1962521443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. R. WILLIAM CORNELL D.D.S

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34106-0429
Country	:	US
Telephone Number	:	239-530-5314
Fax Number	:	239-774-5653

Provider Business Practice Location Address
First Line	:	3301 TAMIAMI TRL E
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34112-3969
Country	:	US
Telephone Number	:	239-530-5314
Fax Number	:	239-774-5653

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/09/2007

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