Provider Demographics
NPI:1457321606
Name:CORNATZER, JOSEPH L (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:L
Last Name:CORNATZER
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 1:33 WINTERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1429
Mailing Address - Country:US
Mailing Address - Phone:302-384-7939
Mailing Address - Fax:
Practice Address - Street 1:7197 LANCASTER PIKE
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-9270
Practice Address - Country:US
Practice Address - Phone:302-239-5917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100012091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039449Medicaid