Individual
DR. CORBET KEVIN ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11233 SHADOW CREEK PKWY STE 120, PEARLAND, TX 77584-7345
(281) 741-5247
(281) 741-5354
Mailing address
1304 DART ST APT A, HOUSTON, TX 77007-6243
(281) 725-0103
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
23589
TX
1223P0221X
Pediatric Dentistry
DEN1000288
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188083306
—
TX
Enumeration date
04/19/2006
Last updated
10/10/2011
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