Provider Demographics
NPI:1801995295
Name:CORCORAN, PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:CORCORAN
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 1:953 S FRONTAGE RD W
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-5710
Mailing Address - Country:US
Mailing Address - Phone:970-476-3991
Mailing Address - Fax:970-476-1625
Practice Address - Street 1:195 W 14TH STE C
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4717
Practice Address - Country:US
Practice Address - Phone:970-945-2840
Practice Address - Fax:970-945-2893
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1047991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice