Provider Demographics
NPI:1306992730
Name:CORBITT, TODD NEAL (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:NEAL
Last Name:CORBITT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14080-9509
Mailing Address - Country:US
Mailing Address - Phone:716-537-2211
Mailing Address - Fax:
Practice Address - Street 1:9 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:NY
Practice Address - Zip Code:14080-9509
Practice Address - Country:US
Practice Address - Phone:716-537-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR38051223G0001X
OK62541223G0001X
LA61421223G0001X
TX00263651223G0001X
OH30-0203041223G0001X
NY0588891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60003662Medicaid
OH0149020Medicaid
OH9179687OtherDORAL