Provider Demographics
NPI:1467509596
Name:CORPUZ, ABRAHAM B (DMD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:B
Last Name:CORPUZ
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 1:73 W MARCH LN
Mailing Address - Street 2:STE. B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5726
Mailing Address - Country:US
Mailing Address - Phone:209-951-0805
Mailing Address - Fax:209-951-5693
Practice Address - Street 1:73 W MARCH LN
Practice Address - Street 2:STE. B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5726
Practice Address - Country:US
Practice Address - Phone:209-951-0805
Practice Address - Fax:209-951-5693
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA397791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice