Provider Demographics
NPI:1447699616
Name:UNITES STATES NAVY
Entity type:Organization
Organization Name:UNITES STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FOR DENTAL SERVICES NMCSD
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:N
Authorized Official - Last Name:KORSNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-532-6471
Mailing Address - Street 1:2832 WOODCREEK RD
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3126
Mailing Address - Country:US
Mailing Address - Phone:850-512-0884
Mailing Address - Fax:
Practice Address - Street 1:NAVAL MEDICAL CTR
Practice Address - Street 2:34800 BOB WILSON DR
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92134-5000
Practice Address - Country:US
Practice Address - Phone:619-532-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK64881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty