Organization
CORCORAN PRIVITERA FAMILY DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRANDON M PRIVITERA DDS (OWNER)
(440) 415-2334
Entity
Organization
Contact information
Practice address
15 SHAKER RUN RD, PEEBLES, OH 45660-9401
(937) 587-3903
Mailing address
415 MARKET ST, PIKETON, OH 45661-9111
(440) 415-2334
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0349182
—
OH
05
—
0349186
—
OH
05
—
0521224
—
OH
01
—
1326603283
NPI
—
01
—
1376586669
NPI
—
01
—
1669037529
NPI
—
Enumeration date
07/15/2022
Last updated
07/15/2022
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