Provider Demographics
NPI:1427284330
Name:CORRADINI, JASON MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:MICHAEL
Last Name:CORRADINI
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 1:8634 N 32ND ST
Mailing Address - Street 2:PO BOX 238
Mailing Address - City:RICHLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49083-8555
Mailing Address - Country:US
Mailing Address - Phone:269-629-7156
Mailing Address - Fax:269-629-3359
Practice Address - Street 1:8634 N 32ND ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:MI
Practice Address - Zip Code:49083-8555
Practice Address - Country:US
Practice Address - Phone:269-629-7156
Practice Address - Fax:269-629-3359
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist