Provider Demographics
NPI:1427000918
Name:ALLEN, CORY TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORY
Middle Name:TAYLOR
Last Name:ALLEN
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 1:2675 BRICKSIDE LANE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466
Mailing Address - Country:US
Mailing Address - Phone:843-216-7488
Mailing Address - Fax:843-216-7489
Practice Address - Street 1:2675 BRICKSIDE LANE
Practice Address - Street 2:SUITE 100
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466
Practice Address - Country:US
Practice Address - Phone:843-216-7488
Practice Address - Fax:843-216-7489
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4635122300000X, 1223G0001X
KY82231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist