Healthcare Provider Details

I. General information

NPI: 1144585886
Provider Name (Legal Business Name): KOREN & ASSOCIATES, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W CHURCH ST
CREEDMOOR NC
27522
US

IV. Provider business mailing address

4112 PLEASANT VALLEY RD STE 212
RALEIGH NC
27612-2634
US

V. Phone/Fax

Practice location:
  • Phone: 919-528-0800
  • Fax:
Mailing address:
  • Phone: 919-528-0800
  • Fax: 888-818-4195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6997
License Number StateNC

VIII. Authorized Official

Name: JANET LYNN CORBLEY
Title or Position: CEO
Credential:
Phone: 919-528-0800