Individual provider Active NPI

William V Cornwell Jr., D.M.D.

  • General Practice Dentistry
  • Montgomery, AL
National Provider Identifier
1710008115
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3324 Issued in AL
Practice address
2895 Zelda Rd
Montgomery, AL 36106-2697
Phone
(334) 819-7377
Fax
(334) 819-7379
NPI assigned
Apr 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 3324 AL Primary

Addresses

Primary practice location

2895 Zelda Rd
Montgomery, AL 36106-2697

Mailing address

2895 Zelda Rd
Montgomery, AL 36106
Phone (334) 819-7377

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160707000590 AL Order and Referring Only - Other (Physician)Practitioner - Other (Physician) 8123310448

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3324ALMDFamily Medicine Physician

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710008115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2895 ZELDA RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "36106",
            "telephone_number": "334-819-7377",
            "fax_number": "334-819-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2895 ZELDA RD",
            "city": "MONTGOMERY",
            "state": "AL",
            "postal_code": "361062697",
            "telephone_number": "334-819-7377",
            "fax_number": "334-819-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORNWELL",
        "first_name": "WILLIAM",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "3324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montgomery, AL

Sources for this page

Verify at the official NPI Registry.