Provider Demographics
NPI:1083780969
Name:KORRECK, BRIAN WINSTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:WINSTON
Last Name:KORRECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-0156
Mailing Address - Country:US
Mailing Address - Phone:847-669-5421
Mailing Address - Fax:847-669-1113
Practice Address - Street 1:12507 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6500
Practice Address - Country:US
Practice Address - Phone:847-669-5421
Practice Address - Fax:847-669-1113
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019025098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist