Provider Demographics
NPI:1366574378
Name:CORBETT, STEVEN G (LD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:G
Last Name:CORBETT
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6799 SW ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-1328
Mailing Address - Country:US
Mailing Address - Phone:503-244-7355
Mailing Address - Fax:
Practice Address - Street 1:300 NW 3RD AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3603
Practice Address - Country:US
Practice Address - Phone:503-266-1800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT-DO-643631122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist