Provider Demographics
NPI:1881033926
Name:FRANK A. CORNELLA DDS, MD PC
Entity Type:Organization
Organization Name:FRANK A. CORNELLA DDS, MD PC
Other - Org Name:ORAL SURGERY OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:A
Authorized Official - Last Name:CORNELLA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:417-881-4546
Mailing Address - Street 1:3237 E SUNSHINE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6919
Mailing Address - Country:US
Mailing Address - Phone:417-881-4546
Mailing Address - Fax:417-883-0443
Practice Address - Street 1:3237 E SUNSHINE ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6919
Practice Address - Country:US
Practice Address - Phone:417-881-4546
Practice Address - Fax:417-883-0443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty