Provider Demographics
NPI:1205152998
Name:CORSI, TONY P (DDS)
Entity type:Individual
Prefix:DR
First Name:TONY
Middle Name:P
Last Name:CORSI
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 1:30050 HOOVER RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-2544
Mailing Address - Country:US
Mailing Address - Phone:586-573-7506
Mailing Address - Fax:
Practice Address - Street 1:30050 HOOVER RD
Practice Address - Street 2:SUITE F
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2544
Practice Address - Country:US
Practice Address - Phone:586-573-7506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012318122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist