Provider Demographics
NPI:1316019086
Name:CORSO, LAWRENCE SAMUEL II (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:SAMUEL
Last Name:CORSO
Suffix:II
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 1:3309 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-2343
Mailing Address - Country:US
Mailing Address - Phone:315-463-0295
Mailing Address - Fax:315-463-0341
Practice Address - Street 1:3309 JAMES ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13206-2343
Practice Address - Country:US
Practice Address - Phone:315-463-0295
Practice Address - Fax:315-463-0341
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0490101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02502523Medicaid