Basic Information
| Provider Information | |||||||||
| NPI: | 1003421157 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORCRAN | ||||||||
| FirstName: | JOSHUA | ||||||||
| MiddleName: | MICHAEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5840 RUNNING HORSE DR | ||||||||
| Address2: | |||||||||
| City: | NORTH LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 890818006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026868025 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4833 S HULEN ST STE 101 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761321427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172944600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 36719 | TX | Y | Dental Providers | Dentist | General Practice |
No ID Information.