Healthcare Provider Details

I. General information

NPI: 1518176502
Provider Name (Legal Business Name): COREY B CHMIL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 LACKAWANNA AVE 3RD FLOOR
SCRANTON PA
18503-2046
US

IV. Provider business mailing address

1669 N KEYSER AVE
SCRANTON PA
18508-1753
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-9136
  • Fax: 570-344-0299
Mailing address:
  • Phone: 570-430-1954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS036530
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: