Provider Demographics
NPI:1568746048
Name:ROWE, CORIE ROYLAND (DMD)
Entity Type:Individual
Prefix:MR
First Name:CORIE
Middle Name:ROYLAND
Last Name:ROWE
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 1:233 E 13TH ST
Mailing Address - Street 2:APT 2303
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3237
Mailing Address - Country:US
Mailing Address - Phone:415-971-0463
Mailing Address - Fax:
Practice Address - Street 1:13161 W 143RD ST
Practice Address - Street 2:SUITE #104
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-6890
Practice Address - Country:US
Practice Address - Phone:415-971-3667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-03
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028834122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist