Provider Demographics
NPI:1194832428
Name:DEEBLE, COREY (DDS)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:DEEBLE
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 1:2803 JOSIE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1515
Mailing Address - Country:US
Mailing Address - Phone:562-429-9192
Mailing Address - Fax:
Practice Address - Street 1:3551 FLORISTA ST
Practice Address - Street 2:#1C
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2474
Practice Address - Country:US
Practice Address - Phone:562-596-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA541351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice