Provider Demographics
NPI:1902984305
Name:CORNETTE, PHILIP III (DMD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:CORNETTE
Suffix:III
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 1:347 W LINCOLN TR
Mailing Address - Street 2:1
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160
Mailing Address - Country:US
Mailing Address - Phone:270-351-3505
Mailing Address - Fax:270-351-3704
Practice Address - Street 1:347 W LINCOLN TR
Practice Address - Street 2:1
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160
Practice Address - Country:US
Practice Address - Phone:270-351-3505
Practice Address - Fax:270-351-3704
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY72961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice