Healthcare Provider Details

I. General information

NPI: 1083780159
Provider Name (Legal Business Name): MAMTA M. KORI D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/23/2026
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3420 ATRIUM BLVD STE 100
MIDDLETOWN OH
45005-5186
US

IV. Provider business mailing address

3420 ATRIUM BLVD STE 100
MIDDLETOWN OH
45005-5186
US

V. Phone/Fax

Practice location:
  • Phone: 855-912-7677
  • Fax: 513-424-1834
Mailing address:
  • Phone: 855-912-7677
  • Fax: 513-424-2147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21541
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: