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Provider Information for 1144304809

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CORNAL RIDGELL D.M.D.

Gender: MALE

Individual NPI: 1144304809

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1144304809
Enumeration Date 2006-10-25
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 21700 NORTHWESTERN HWY SUITE 180
SOUTHFIELD, MI 48075-4906
United States

Phone: 248-423-9393 | Fax: 248-423-7893
View Map External Link
Primary Practice Address 21700 NORTHWESTERN HWY SUITE 180
SOUTHFIELD, MI 48075-4906
United States

Phone: 248-423-9393 | Fax: 248-423-7893
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223G0001X - Dentist General Practice MI 2901015775