Provider Demographics
NPI:1780702415
Name:CORSELLI, RONALD JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAMES
Last Name:CORSELLI
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 1:2316 CAMELBACK DR.
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509
Mailing Address - Country:US
Mailing Address - Phone:925-706-1823
Mailing Address - Fax:
Practice Address - Street 1:3432 HILLCREST AVENUE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531
Practice Address - Country:US
Practice Address - Phone:925-754-2145
Practice Address - Fax:925-754-2446
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist