Individual
DR. GLEN J CORCORAN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3701 HIGHWAY 59, SUITE E, MANDEVILLE, LA 70471-1905
(985) 871-9733
Mailing address
3101 GROVE CT, MANDEVILLE, LA 70448-8485
(985) 626-5582
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4477
LA
Other
Enumeration date
02/23/2006
Last updated
07/08/2007
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