Provider Demographics
NPI:1104917376
Name:CRIDER, CORI KUHTA (DDS)
Entity type:Individual
Prefix:
First Name:CORI
Middle Name:KUHTA
Last Name:CRIDER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2444 PACKARD RD
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-1822
Mailing Address - Country:US
Mailing Address - Phone:734-572-4428
Mailing Address - Fax:734-572-4610
Practice Address - Street 1:2444 PACKARD RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1822
Practice Address - Country:US
Practice Address - Phone:734-572-4428
Practice Address - Fax:734-572-4610
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015024122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist