Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 041411129 | VA |
NPI | 1619945243 |
---|---|
Provider Name | Dr. James Killinger Cornick |
First Address | Moneta, VA 24121-2306 |
Second Address | New Castle, VA 24127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2006 |
Last Update Date | 18/11/2011 |