Healthcare Provider Details

I. General information

NPI: 1487872610
Provider Name (Legal Business Name): CORY DAVID PRICE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5991 SOUTH 3500 WEST PRICE ORTHODONTICS SUITE 200
ROY UT
84067-6701
US

IV. Provider business mailing address

5991 SOUTH 3500 WEST SUITE 200
ROY UT
84067-6701
US

V. Phone/Fax

Practice location:
  • Phone: 801-985-1669
  • Fax:
Mailing address:
  • Phone: 801-985-1669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number328504-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: