Individual
DR. GERALD ROGER CORCORAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
210 N MAIN ST, SUITE 103, DE FOREST, WI 53532-1163
(608) 846-3948
(608) 846-7526
Mailing address
21 NORTH MAIN STREET, SUITE 103, DE FOREST, WI 53532
(608) 846-3948
(608) 846-7526
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2412
WI
Other
Enumeration date
07/03/2008
Last updated
07/03/2008
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