Provider Demographics
NPI:1578608121
Name:CORNILS, WILLIAM P (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:P
Last Name:CORNILS
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:449 E MAIN STREET
Mailing Address - City:HAGERSTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47346
Mailing Address - Country:US
Mailing Address - Phone:765-489-4440
Mailing Address - Fax:765-489-4440
Practice Address - Street 1:449 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346
Practice Address - Country:US
Practice Address - Phone:765-489-4440
Practice Address - Fax:765-489-4440
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007331122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist