Active NPI
Mitchell Corson, D.D.S.
- Dentist
- Philadelphia, PA
National Provider Identifier
1174501696
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS14219L
- Practice address
- 9990 Verree Rd
Philadelphia, PA 19115-1322 - Phone
- (215) 813-9292
- Fax
- (609) 350-7022
- NPI assigned
- Jan 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS14219L | PA | Primary |
Addresses
Primary practice location
9990 Verree Rd
Philadelphia, PA 19115-1322
Mailing address
9733 Bustleton Ave
Philadelphia, PA 19115-3201
Phone (215) 813-9292
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS14219L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136332800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1318464000000",
"number": "1174501696",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9733 BUSTLETON AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191153201",
"telephone_number": "215-813-9292",
"fax_number": "609-350-7022"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9990 VERREE RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191151322",
"telephone_number": "215-813-9292",
"fax_number": "609-350-7022"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORSON",
"first_name": "MITCHELL",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-04",
"last_updated": "2011-10-13",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS14219L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.