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General NPI Number Information
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NPI Number | 1548433329
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Entity Type | Organization
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Legal Business Name | KIM P. KORNEGAY, DMD
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Dates
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Enumeration Date | 04/11/2008
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Last Update Date | 04/11/2008
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Provider Practice Location Address
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Address Line | 711 KORNEGAY DR SUITE A
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City | PRATTVILLE
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State | AL
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Zip | 36066-7715
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Country | US
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Telephone | 334-285-7111
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Fax | 334-285-3310
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Provider Business Mailing Address
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Address Line | 711 KORNEGAY DR SUITE A
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City | PRATTVILLE
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State | AL
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Zip | 36066-7715
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Country | US
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Telephone | 334-285-7111
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Fax | 334-285-3310
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIM PIERSON KORNEGAY
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Credential | DMD
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Telephone | 334-285-7111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | CS3863
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License Number State | AL
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