Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DDS63323 | CA |
NPI | 1013515774 |
---|---|
Provider Name | Andrew Irvine Corbett |
First Address | Ukiah, CA 95482-4591 |
Second Address | Ukiah, CA 95482-4591 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2020 |
Last Update Date | 14/10/2020 |