Provider Demographics
NPI:1730285156
Name:CORBET, JEFFERY LAMAR (DDS)
Entity Type:Individual
Prefix:
First Name:JEFFERY
Middle Name:LAMAR
Last Name:CORBET
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2205 HARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-3607
Mailing Address - Country:US
Mailing Address - Phone:817-354-0606
Mailing Address - Fax:817-354-1015
Practice Address - Street 1:2205 HARWOOD RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-3607
Practice Address - Country:US
Practice Address - Phone:817-354-0606
Practice Address - Fax:817-354-1015
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice