Provider Demographics
NPI:1346259546
Name:CORKRAN, DEBORAH BEVILL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:BEVILL
Last Name:CORKRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:B
Other - Last Name:CORKRAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2717 BELLEVUE AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-3233
Mailing Address - Country:US
Mailing Address - Phone:315-476-3291
Mailing Address - Fax:315-476-8924
Practice Address - Street 1:2717 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-3233
Practice Address - Country:US
Practice Address - Phone:315-476-3291
Practice Address - Fax:315-476-8924
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04567122300000X
NY0456741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist