Provider Demographics
NPI:1619181708
Name:CORSON, GEORGE MICHAEL V (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:MICHAEL
Last Name:CORSON
Suffix:V
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 1:5307 E YALE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-6901
Mailing Address - Country:US
Mailing Address - Phone:303-825-3818
Mailing Address - Fax:303-825-3819
Practice Address - Street 1:5307 E YALE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-6901
Practice Address - Country:US
Practice Address - Phone:303-825-3818
Practice Address - Fax:303-825-3819
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69161223G0001X
CO8567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice