Healthcare Provider Details

I. General information

NPI: 1205046281
Provider Name (Legal Business Name): CORNELIUS MAURICE PRYOR III D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 12/21/2025
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3824 COOL MEADOWS DR
LAS VEGAS NV
89129-6872
US

IV. Provider business mailing address

4139 2ND AVE
LOS ANGELES CA
90008-4001
US

V. Phone/Fax

Practice location:
  • Phone: 323-839-8238
  • Fax:
Mailing address:
  • Phone: 323-839-8238
  • Fax: 702-307-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7957
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: