Provider Demographics
NPI:1316195738
Name:CORNISH, NICOLE E (DMD)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:E
Last Name:CORNISH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W CUNNINGHAM ST STE 204
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-5791
Mailing Address - Country:US
Mailing Address - Phone:724-256-5890
Mailing Address - Fax:724-256-5893
Practice Address - Street 1:222 W CUNNINGHAM ST STE 204
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5791
Practice Address - Country:US
Practice Address - Phone:724-256-5890
Practice Address - Fax:724-256-5893
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036332122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist