Provider Demographics
NPI:1275722936
Name:WILLIAM R. CORNETTE D.D.S, P.C.
Entity Type:Organization
Organization Name:WILLIAM R. CORNETTE D.D.S, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-827-7770
Mailing Address - Street 1:1817 TODDS LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-3124
Mailing Address - Country:US
Mailing Address - Phone:757-827-7770
Mailing Address - Fax:
Practice Address - Street 1:1817 TODDS LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3124
Practice Address - Country:US
Practice Address - Phone:757-827-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010054411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty