Individual
JEFFREY WYNN CORLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
508 PITTSBURGH STREET, MARS PROFESSIONAL BLDG SUITE 201, MARS, PA 16046-0438
(724) 625-3151
Mailing address
PO BOX 438, MARS, PA 16046-0438
(724) 625-3151
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS020043L
PA
Other
Enumeration date
08/02/2006
Last updated
07/08/2007
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