1912130733 NPI number — DR. TOBIAS WILSON CORCORAN DDS

Table of content: DR. TOBIAS WILSON CORCORAN DDS (NPI 1912130733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912130733 NPI number — DR. TOBIAS WILSON CORCORAN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORCORAN
Provider First Name:
TOBIAS
Provider Middle Name:
WILSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912130733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
607 OAKWOOD AVE
Provider Second Line Business Mailing Address:
AURORA SMILES PEDIATRIC DENTISTRY
Provider Business Mailing Address City Name:
EAST AURORA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
716-710-2888
Provider Business Mailing Address Fax Number:
716-805-7001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
607 OAKWOOD AVE
Provider Second Line Business Practice Location Address:
AURORA SMILES PEDIATRIC DENTISTRY
Provider Business Practice Location Address City Name:
EAST AURORA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14052-2354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
716-710-2888
Provider Business Practice Location Address Fax Number:
716-805-7001
Provider Enumeration Date:
08/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  054000 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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