Provider Demographics
NPI:1306868492
Name:VANBRUNT DDS PC, CORBYN L (DDS PC)
Entity type:Individual
Prefix:
First Name:CORBYN
Middle Name:L
Last Name:VANBRUNT DDS PC
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6565 S. YALE AVE.
Mailing Address - Street 2:SUITE 1103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136
Mailing Address - Country:US
Mailing Address - Phone:918-481-4910
Mailing Address - Fax:918-481-4917
Practice Address - Street 1:6565 S. YALE AVE.
Practice Address - Street 2:SUITE 1103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136
Practice Address - Country:US
Practice Address - Phone:918-481-4910
Practice Address - Fax:918-481-4917
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54451223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice