Provider Demographics
NPI:1033974415
Name:EISNER, COREY (DMD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:EISNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 WICKLOW LN
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3627
Mailing Address - Country:US
Mailing Address - Phone:949-280-7787
Mailing Address - Fax:
Practice Address - Street 1:417 WICKLOW LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-3627
Practice Address - Country:US
Practice Address - Phone:949-280-7787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-15
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program