Provider Demographics
NPI:1972654408
Name:CORBETT, JOHN A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:CORBETT
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:CORBETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, MS, PC
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-0611
Mailing Address - Country:US
Mailing Address - Phone:979-297-2390
Mailing Address - Fax:979-297-6115
Practice Address - Street 1:135 OYSTER CREEK DR
Practice Address - Street 2:SUITE U
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-4183
Practice Address - Country:US
Practice Address - Phone:979-297-4059
Practice Address - Fax:979-297-6115
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics