Provider Demographics
NPI:1891090833
Name:KORN, MICHAEL S (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:KORN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 E DANBURY RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-7502
Mailing Address - Country:US
Mailing Address - Phone:206-949-0659
Mailing Address - Fax:
Practice Address - Street 1:9000 W THUNDERBIRD RD STE 200
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4435
Practice Address - Country:US
Practice Address - Phone:480-493-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-24
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60198986122300000X
AZD011263122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist