Provider Demographics
NPI:1811035884
Name:MARK CORN DDS PC
Entity Type:Organization
Organization Name:MARK CORN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PC
Authorized Official - Phone:574-293-7032
Mailing Address - Street 1:902 COUNTY ROAD 6 E
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-5571
Mailing Address - Country:US
Mailing Address - Phone:574-293-7032
Mailing Address - Fax:
Practice Address - Street 1:902 COUNTY ROAD 6 E
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-5571
Practice Address - Country:US
Practice Address - Phone:574-293-7032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008896A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty