Provider Demographics
NPI:1982824744
Name:MCCORKLE, MASTON R JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:MASTON
Middle Name:R
Last Name:MCCORKLE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:6220 PETERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-4040
Mailing Address - Country:US
Mailing Address - Phone:540-563-1640
Mailing Address - Fax:540-362-8011
Practice Address - Street 1:6220 PETERS CREEK RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4040
Practice Address - Country:US
Practice Address - Phone:540-563-1640
Practice Address - Fax:540-362-8011
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA53351223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics