Provider Demographics
NPI:1518176502
Name:CHMIL, COREY B (DMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:B
Last Name:CHMIL
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 1:1669 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1753
Mailing Address - Country:US
Mailing Address - Phone:570-430-1954
Mailing Address - Fax:
Practice Address - Street 1:600 LACKAWANNA AVE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-2046
Practice Address - Country:US
Practice Address - Phone:570-342-9136
Practice Address - Fax:570-344-0299
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS036530122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist