Provider Demographics
NPI:1649535865
Name:DENIS S. CORRAL, D.D.S., P.C.
Entity type:Organization
Organization Name:DENIS S. CORRAL, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-694-6640
Mailing Address - Street 1:11901 BUSINESS BLVD., #201
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7701
Mailing Address - Country:US
Mailing Address - Phone:907-694-6640
Mailing Address - Fax:907-694-6681
Practice Address - Street 1:11901 BUSINESS BLVD., #201
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7701
Practice Address - Country:US
Practice Address - Phone:907-694-6640
Practice Address - Fax:907-694-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA552122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty