MEDICARE: COREY FOULK

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	122300000X	Dentist	7652	NV
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1780329250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY FOULK

Provider Business Mailing Address
First Line	:	297 ELDER VIEW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89138-5011
Country	:	US
Telephone Number	:	775-843-2303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W CHARLESTON BLVD BLDG D
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89102-2335
Country	:	US
Telephone Number	:	775-453-0270
Fax Number	:

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

Provider Enumeration Date	:	04/29/2022
Last Update Date	:	08/29/2022

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Directions to “ COREY FOULK ” Practice Location

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