Provider Demographics
NPI:1326576398
Name:JAMESON, CORY CRAVEN II (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:CRAVEN
Last Name:JAMESON
Suffix:II
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 S BAXTER DR
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-0139
Mailing Address - Country:US
Mailing Address - Phone:527-226-8152
Mailing Address - Fax:
Practice Address - Street 1:2001 S BAXTER DR
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-0139
Practice Address - Country:US
Practice Address - Phone:527-226-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-02
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC108361223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty