Provider Demographics
NPI:1023143450
Name:CORNS, ALAN EDWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:EDWARD
Last Name:CORNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:E
Other - Last Name:CORNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS PC
Mailing Address - Street 1:809 WALL STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2570
Mailing Address - Country:US
Mailing Address - Phone:219-462-2564
Mailing Address - Fax:219-548-2668
Practice Address - Street 1:809 WALL STREET
Practice Address - Street 2:SUITE C
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2570
Practice Address - Country:US
Practice Address - Phone:219-462-2564
Practice Address - Fax:219-548-2668
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN5996122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist