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General NPI Number Information
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NPI Number | 1033974415
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Entity Type | Individual
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Provider Name | COREY EISNER DMD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2024
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 437 BAUSKETT ST
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City | EDGEFIELD
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State | SC
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Zip | 29824-4501
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Country | US
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Telephone | 803-232-7346
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 WHITNEY ST
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City | AUGUSTA
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State | GA
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Zip | 30904-6217
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Country | US
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Telephone | 949-280-7787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123500
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 11190
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License Number State | SC
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