Provider Demographics
NPI:1043317944
Name:ACREE, COREY ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ROBERT
Last Name:ACREE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 COFFEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4229
Mailing Address - Country:US
Mailing Address - Phone:209-529-0674
Mailing Address - Fax:209-529-1437
Practice Address - Street 1:1213 COFFEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4229
Practice Address - Country:US
Practice Address - Phone:209-529-0674
Practice Address - Fax:209-529-1437
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist