Provider Demographics
NPI:1346781903
Name:CORNICK, GABRIEL HARRIS (DMD, MBS)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:HARRIS
Last Name:CORNICK
Suffix:
Gender:M
Credentials:DMD, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E SOMERSET ST
Mailing Address - Street 2:
Mailing Address - City:RARITAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08869-2113
Mailing Address - Country:US
Mailing Address - Phone:908-725-1525
Mailing Address - Fax:908-725-4890
Practice Address - Street 1:64 E SOMERSET ST
Practice Address - Street 2:
Practice Address - City:RARITAN
Practice Address - State:NJ
Practice Address - Zip Code:08869
Practice Address - Country:US
Practice Address - Phone:908-725-1525
Practice Address - Fax:908-725-4890
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027224001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice