MEDICARE: DR. SAMUEL LOUIS COREY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12009461A	IN

General Provider Information

NPI Number	:	1083701734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL LOUIS COREY D.D.S.

Provider Business Mailing Address
First Line	:	10216 DUPONT CIRCLE DR E
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1611
Country	:	US
Telephone Number	:	260-489-0078
Fax Number	:	260-490-5106

Provider Business Practice Location Address
First Line	:	10216 DUPONT CIRCLE DR E
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1611
Country	:	US
Telephone Number	:	260-489-0078
Fax Number	:	260-490-5106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	08/18/2022

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