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General NPI Number Information
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NPI Number | 1780329250
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Entity Type | Individual
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Provider Name | COREY FOULK
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Gender | Male
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 08/29/2022
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Provider Practice Location Address
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Address Line | 1700 W CHARLESTON BLVD BLDG D
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City | LAS VEGAS
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State | NV
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Zip | 89102-2335
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Country | US
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Telephone | 775-453-0270
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Fax |
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Provider Business Mailing Address
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Address Line | 297 ELDER VIEW DR
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City | LAS VEGAS
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State | NV
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Zip | 89138-5011
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Country | US
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Telephone | 775-843-2303
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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 | 7652
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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