Provider Demographics
NPI:1356322838
Name:CORNELLA, FRANK ANTHONY (DDS, MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:ANTHONY
Last Name:CORNELLA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 E SUNSHINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6919
Mailing Address - Country:US
Mailing Address - Phone:417-881-4546
Mailing Address - Fax:417-883-0443
Practice Address - Street 1:3237 E SUNSHINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6919
Practice Address - Country:US
Practice Address - Phone:417-881-4546
Practice Address - Fax:417-883-0443
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO114534208600000X
MO0157981223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209802610Medicaid
MO409802618Medicaid