Provider Demographics
NPI:1447591755
Name:RALPH M. CORPUZ, DDS, PC
Entity Type:Organization
Organization Name:RALPH M. CORPUZ, DDS, PC
Other - Org Name:CORPUZ FAMILY DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPLH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-334-5656
Mailing Address - Street 1:5311 S 138TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-2913
Mailing Address - Country:US
Mailing Address - Phone:402-334-5656
Mailing Address - Fax:402-330-3949
Practice Address - Street 1:5311 S 138TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2913
Practice Address - Country:US
Practice Address - Phone:402-334-5656
Practice Address - Fax:402-330-3949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-12
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty