Provider Demographics
NPI:1609274539
Name:JASON M. CORRADINI D.D.S., PLLC
Entity Type:Organization
Organization Name:JASON M. CORRADINI D.D.S., PLLC
Other - Org Name:JASON M. CORRADINI
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:LUCINDA
Authorized Official - Last Name:CORRADINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-808-7974
Mailing Address - Street 1:8634 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8555
Mailing Address - Country:US
Mailing Address - Phone:269-629-7156
Mailing Address - Fax:269-629-3359
Practice Address - Street 1:8634 N 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8555
Practice Address - Country:US
Practice Address - Phone:269-629-7156
Practice Address - Fax:269-629-3359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020022302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization