Provider Demographics
NPI:1275191694
Name:DULIN, CORY IRENE
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:IRENE
Last Name:DULIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1894 TEAL DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1104
Mailing Address - Country:US
Mailing Address - Phone:406-249-8903
Mailing Address - Fax:
Practice Address - Street 1:340 W CENTER ST
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4032
Practice Address - Country:US
Practice Address - Phone:406-755-7123
Practice Address - Fax:406-755-7124
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11726124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist