Provider Demographics
NPI:1649388653
Name:MASON DENTAL CENTER, MATTHEW A CORCORAN, DDS
Entity Type:Organization
Organization Name:MASON DENTAL CENTER, MATTHEW A CORCORAN, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CORCORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-398-5946
Mailing Address - Street 1:317 READING RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1567
Mailing Address - Country:US
Mailing Address - Phone:513-398-5946
Mailing Address - Fax:
Practice Address - Street 1:317 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1567
Practice Address - Country:US
Practice Address - Phone:513-398-5946
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-96701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty