Provider Demographics
NPI:1922442243
Name:KORNBLATT, MICHAEL ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:KORNBLATT
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 1:2917 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-6916
Mailing Address - Country:US
Mailing Address - Phone:812-284-2103
Mailing Address - Fax:812-590-2077
Practice Address - Street 1:2917 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6916
Practice Address - Country:US
Practice Address - Phone:812-284-2103
Practice Address - Fax:812-590-2077
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012408A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry