Provider Demographics
NPI:1245559822
Name:CORNILS, THOMAS CHASE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHASE
Last Name:CORNILS
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 1:2016 W MCGALLIARD RD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-2148
Mailing Address - Country:US
Mailing Address - Phone:765-284-7242
Mailing Address - Fax:765-289-8331
Practice Address - Street 1:2016 W MCGALLIARD RD
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2148
Practice Address - Country:US
Practice Address - Phone:765-284-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-22
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011436A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice