Provider Demographics
NPI:1417107160
Name:MURRAY, COREY CORNELIUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:CORNELIUS
Last Name:MURRAY
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:PO BOX 43564
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-9564
Mailing Address - Country:US
Mailing Address - Phone:202-508-0526
Mailing Address - Fax:
Practice Address - Street 1:425 2ND STREET NW
Practice Address - Street 2:FEDERAL CCNV DENTAL CLINIC
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001
Practice Address - Country:US
Practice Address - Phone:202-508-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000730122300000X
MD-141661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024918300Medicaid