Provider Demographics
NPI:1376617324
Name:CORSIG, KENNETH TOPPIN (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:TOPPIN
Last Name:CORSIG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 RANDOLPH RD
Mailing Address - Street 2:SUITE 103-R
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1032
Mailing Address - Country:US
Mailing Address - Phone:704-365-0123
Mailing Address - Fax:704-364-8640
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:SUITE 103-R
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1032
Practice Address - Country:US
Practice Address - Phone:704-365-0123
Practice Address - Fax:704-364-8640
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63281223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics