Provider Demographics
NPI:1417228032
Name:CORRY, DOUGLAS WILLIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WILLIS
Last Name:CORRY
Suffix:
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 1:427 S MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-3957
Mailing Address - Country:US
Mailing Address - Phone:435-586-6526
Mailing Address - Fax:435-867-9230
Practice Address - Street 1:427 S MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-3957
Practice Address - Country:US
Practice Address - Phone:435-586-6526
Practice Address - Fax:435-867-9230
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271301223G0001X
UT8705196122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice