Provider Demographics
NPI:1518004498
Name:CORRAL, DENIS SALVADOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DENIS
Middle Name:SALVADOR
Last Name:CORRAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11901 BUSINESS BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7726
Mailing Address - Country:US
Mailing Address - Phone:907-694-6640
Mailing Address - Fax:907-694-6681
Practice Address - Street 1:11901 BUSINESS BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7726
Practice Address - Country:US
Practice Address - Phone:907-694-6640
Practice Address - Fax:907-694-6681
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist