Michael G Correale, DMD
Individual provider Active NPI Dentist · Leadington, MO
NPI 1891815585 · NPPES record last updated Oct 29, 2009
Key facts
- NPI
- 1891815585
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 13428 (MO)
- Practice address
- 111 Saint Francois PLZ
Leadington, MO 63601-4454 - Phone
- (573) 431-5155
- Fax
- (573) 421-0576
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13428 | MO | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 13428 | MO | Yes |
Addresses
Primary practice location
111 Saint Francois PLZ
Leadington, MO 63601-4454
Mailing address
111 Saint Francois PLZ
Leadington, MO 63601-4454
Phone (573) 431-5155
Other names
- St Francois Plaza Dental Center
Other providers in Leadington, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.