Provider Demographics
NPI:1063605830
Name:CORY, KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:CORY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 HAWK PKWY
Mailing Address - Street 2:#7
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-6453
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1425 HAWK PKWY
Practice Address - Street 2:#7
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-6453
Practice Address - Country:US
Practice Address - Phone:970-249-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist