Provider Demographics
NPI:1821281668
Name:CORSI HOEY PEARSON PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:CORSI HOEY PEARSON PROFESSIONAL CORP.
Other - Org Name:SANTA ROSA ORAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HOEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-545-4940
Mailing Address - Street 1:1174 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407
Mailing Address - Country:US
Mailing Address - Phone:707-545-4625
Mailing Address - Fax:707-545-4940
Practice Address - Street 1:1174 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407
Practice Address - Country:US
Practice Address - Phone:707-545-4625
Practice Address - Fax:707-545-4940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19771ZMedicare PIN