Provider Demographics
NPI:1114638640
Name:COREY INBODEN DDS, PLLC
Entity Type:Organization
Organization Name:COREY INBODEN DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COREY
Authorized Official - Last Name:INBODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-219-4046
Mailing Address - Street 1:2350 E GOLDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3152
Mailing Address - Country:US
Mailing Address - Phone:870-219-4046
Mailing Address - Fax:
Practice Address - Street 1:179 N CHURCH AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5265
Practice Address - Country:US
Practice Address - Phone:479-442-6512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental