Douglas Joe Cornish, DMD
Individual provider Active NPI Dentist · Crandall, TX
NPI 1902094592 · NPPES record last updated Jan 4, 2021
Key facts
- NPI
- 1902094592
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 27829 (TX)
- Practice address
- 1101 E Hwy 175
Ste 700
Crandall, TX 75114 - Phone
- (972) 427-0333
- Fax
- (972) 472-3908
- NPI assigned
- Oct 9, 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 |
|---|---|---|---|
| 27829 | TX | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 27829 | TX | Yes |
Addresses
Primary practice location
1101 E Hwy 175
Ste 700
Crandall, TX 75114
Mailing address
1101 E Hwy 175
Ste 700
Crandall, TX 75114
Phone (972) 427-0333
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Crandall | Other |
Other providers in Crandall, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 4, 2021. 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.