Individual
MARK CORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
902 COUNTY ROAD 6 E, ELKHART, IN 46514-5571
(574) 293-7032
Mailing address
902 CR 6 EAST, ELKHART, IN 46514-5571
(574) 293-7032
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008896A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100133710A
—
IN
Enumeration date
02/02/2007
Last updated
07/08/2007
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