Provider Demographics
NPI:1194825919
Name:DIKE, COREY CARLYLE (DDS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:CARLYLE
Last Name:DIKE
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 1:2511 COURT ST
Mailing Address - Street 2:
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54494-6130
Mailing Address - Country:US
Mailing Address - Phone:715-252-7777
Mailing Address - Fax:715-345-9808
Practice Address - Street 1:2906 POST RD
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-6417
Practice Address - Country:US
Practice Address - Phone:715-345-7770
Practice Address - Fax:715-345-9808
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001601-015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist