Provider Demographics
NPI:1790830305
Name:CORRAO, THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CORRAO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8420
Mailing Address - Country:US
Mailing Address - Phone:631-665-2052
Mailing Address - Fax:
Practice Address - Street 1:270 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8420
Practice Address - Country:US
Practice Address - Phone:631-665-2052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0388551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice