Provider Demographics
NPI:1588930515
Name:KORNBROT, ANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:KORNBROT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 WALNUT ST STE 902
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-2905
Mailing Address - Country:US
Mailing Address - Phone:215-563-6263
Mailing Address - Fax:215-563-9898
Practice Address - Street 1:1601 WALNUT ST STE 902
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-2905
Practice Address - Country:US
Practice Address - Phone:215-563-6263
Practice Address - Fax:215-563-9898
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021370L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist