Provider Demographics
NPI:1023148244
Name:CORNELIUS, JANINE K (DDS)
Entity type:Individual
Prefix:DR
First Name:JANINE
Middle Name:K
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3317 W MULLEN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4657
Mailing Address - Country:US
Mailing Address - Phone:813-382-4630
Mailing Address - Fax:
Practice Address - Street 1:3317 W MULLEN AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4657
Practice Address - Country:US
Practice Address - Phone:813-382-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL121401223P0300X
FLDN121401223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics