Healthcare Provider Details

I. General information

NPI: 1407970205
Provider Name (Legal Business Name): ED CORYELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 HENDERSONVILLE RD
ASHEVILLE NC
28803-2868
US

IV. Provider business mailing address

123 HENDERSONVILLE RD DENTAL HEALTH CENTER
ASHEVILLE NC
28803-2868
US

V. Phone/Fax

Practice location:
  • Phone: 828-772-4223
  • Fax:
Mailing address:
  • Phone: 828-252-4290
  • Fax: 828-210-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8340
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: