Provider Demographics
NPI:1063584936
Name:ACORD, KORIE DUNHOFT (DMD)
Entity type:Individual
Prefix:DR
First Name:KORIE
Middle Name:DUNHOFT
Last Name:ACORD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KORIE
Other - Middle Name:LYNN
Other - Last Name:DUNHOFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2120 HIGH WICKHAM PL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5902
Mailing Address - Country:US
Mailing Address - Phone:502-254-6097
Mailing Address - Fax:502-254-6098
Practice Address - Street 1:2120 HIGH WICKHAM PL
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-5902
Practice Address - Country:US
Practice Address - Phone:502-254-6097
Practice Address - Fax:502-254-6098
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8585122300000X
KY8591223P0221X
DEG1-12191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000040655Medicaid
KY7100131700Medicaid