Provider Demographics
NPI:1902094592
Name:CORNISH, DOUGLAS JOE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOE
Last Name:CORNISH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E HWY 175
Mailing Address - Street 2:STE 700
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114
Mailing Address - Country:US
Mailing Address - Phone:972-427-0333
Mailing Address - Fax:972-472-3908
Practice Address - Street 1:1101 E HWY 175
Practice Address - Street 2:STE 700
Practice Address - City:CRANDALL
Practice Address - State:TX
Practice Address - Zip Code:75114
Practice Address - Country:US
Practice Address - Phone:972-427-0333
Practice Address - Fax:972-472-3908
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist