Provider Demographics
NPI:1053584417
Name:KORNMEHL, MARVIN A (DDS)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:KORNMEHL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 CANDLEWOOD COMMONS
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2168
Mailing Address - Country:US
Mailing Address - Phone:732-364-1323
Mailing Address - Fax:732-364-1322
Practice Address - Street 1:103 CANDLEWOOD COMMONS
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2168
Practice Address - Country:US
Practice Address - Phone:732-364-1323
Practice Address - Fax:732-364-1322
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1015728001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics