MEDICARE: CORY IRENE DULIN

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	124Q00000X	Dental Hygienist	11726	MT

General Provider Information

NPI Number	:	1275191694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORY IRENE DULIN

Provider Business Mailing Address
First Line	:	1894 TEAL DR
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-1104
Country	:	US
Telephone Number	:	406-249-8903
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 W CENTER ST
Second Line	:
City	:	KALISPELL
State	:	MT
Zip	:	59901-4032
Country	:	US
Telephone Number	:	406-755-7123
Fax Number	:	406-755-7124

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

Provider Enumeration Date	:	05/31/2019
Last Update Date	:	05/31/2019

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Directions to “ CORY IRENE DULIN ” Practice Location

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