Provider Demographics
NPI:1982850822
Name:KORCORT ENTERPRISES, INC.
Entity Type:Organization
Organization Name:KORCORT ENTERPRISES, INC.
Other - Org Name:SHELBOURNE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:CORTELLESSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-779-0610
Mailing Address - Street 1:6 LAFITTE CT
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-1852
Mailing Address - Country:US
Mailing Address - Phone:610-779-0610
Mailing Address - Fax:610-779-9252
Practice Address - Street 1:1270 SHELBOURNE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-9022
Practice Address - Country:US
Practice Address - Phone:610-779-0610
Practice Address - Fax:610-779-9252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026922L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty