Organization
DEFOREST DENTAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GERALD ROGER CORCORAN DDS (PRESIDENT)
(608) 846-3948
Entity
Organization
Contact information
Practice address
210 N. MAIN ST., STE 103, DEFOREST, WI 53532
(608) 846-3948
(608) 846-7526
Mailing address
210 N. MAIN ST., STE 103, DEFOREST, WI 53532
(608) 846-3948
(608) 846-7526
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2412WI
WI
Other
Enumeration date
09/07/2006
Last updated
08/22/2020
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