Provider Demographics
NPI:1184615015
Name:DYSON, CORNELIUS LEON (DDS)
Entity type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:LEON
Last Name:DYSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BELVIDERE AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-1417
Mailing Address - Country:US
Mailing Address - Phone:908-835-3500
Mailing Address - Fax:908-835-8846
Practice Address - Street 1:134 BELVIDERE AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-1417
Practice Address - Country:US
Practice Address - Phone:908-835-3500
Practice Address - Fax:908-835-8846
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI2171301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry