Provider Demographics
NPI:1093889768
Name:CORSELLO, GREGG M (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:M
Last Name:CORSELLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4725 MCKNIGHT RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-3414
Mailing Address - Country:US
Mailing Address - Phone:412-366-5555
Mailing Address - Fax:412-366-9941
Practice Address - Street 1:4725 MCKNIGHT RD
Practice Address - Street 2:SUITE 215
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-3414
Practice Address - Country:US
Practice Address - Phone:412-366-5555
Practice Address - Fax:412-366-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS-023644-L1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics