Provider Demographics
NPI:1508394644
Name:GOLCHERT, KORY JOHN (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:KORY
Middle Name:JOHN
Last Name:GOLCHERT
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7705
Mailing Address - Country:US
Mailing Address - Phone:949-644-0595
Mailing Address - Fax:949-644-5082
Practice Address - Street 1:1441 AVOCADO AVE STE 401
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7705
Practice Address - Country:US
Practice Address - Phone:949-644-0595
Practice Address - Fax:949-644-5082
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102387122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program