Provider Demographics
NPI:1710608781
Name:CORLISS J FURBERT, DDS,PA
Entity Type:Organization
Organization Name:CORLISS J FURBERT, DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORLISS
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FURBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-295-5849
Mailing Address - Street 1:304 HINTON OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-8195
Mailing Address - Country:US
Mailing Address - Phone:919-295-5849
Mailing Address - Fax:
Practice Address - Street 1:304 HINTON OAKS BLVD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8195
Practice Address - Country:US
Practice Address - Phone:919-295-5849
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty