Provider Demographics
NPI:1962492447
Name:KORSNES, JEFFREY NILS (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:NILS
Last Name:KORSNES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 557
Mailing Address - Street 2:BOX 3266
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96379-3266
Mailing Address - Country:US
Mailing Address - Phone:01181611-723-4768
Mailing Address - Fax:
Practice Address - Street 1:3D DENTAL BATTALION/US NAVAL DENTAL DENTER
Practice Address - Street 2:3D MLG, CAMP HANSEN, UNIT 38452,
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96604-0259
Practice Address - Country:US
Practice Address - Phone:01181-645-3085
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010150481223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics