Individual
ERNST A. CORNIELSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
312 CENTER ST, LAKE GENEVA, WI 53147-1904
(262) 248-2868
(262) 248-7274
Mailing address
W3627 WILDWOOD DR, LAKE GENEVA, WI 53147-3568
(262) 248-2868
(262) 248-7274
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
1732-G
WI
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
IL
Other
Enumeration date
08/03/2006
Last updated
07/08/2007
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