Healthcare Provider Details

I. General information

NPI: 1558297101
Provider Name (Legal Business Name): KORY GOLCHERT DDS A DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17542 IRVINE BLVD STE A
TUSTIN CA
92780-3155
US

IV. Provider business mailing address

5411 SIERRA VERDE RD
IRVINE CA
92603-3842
US

V. Phone/Fax

Practice location:
  • Phone: 714-547-8494
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. KORY JOHN GOLCHERT
Title or Position: PRESIDENT
Credential: DDS
Phone: 916-216-1415