Provider Demographics
NPI:1306867130
Name:CORMIER, DAVID C (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:CORMIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 CABOT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2515
Mailing Address - Country:US
Mailing Address - Phone:978-927-0324
Mailing Address - Fax:978-927-9166
Practice Address - Street 1:495 CABOT ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-2515
Practice Address - Country:US
Practice Address - Phone:978-927-0324
Practice Address - Fax:978-927-9166
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA166771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice