Provider Demographics
NPI:1578745147
Name:ROBINSON, KORI D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KORI
Middle Name:D
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KORI
Other - Middle Name:DANIELLE
Other - Last Name:HARDAWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:4014 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2205
Mailing Address - Country:US
Mailing Address - Phone:214-821-6468
Mailing Address - Fax:
Practice Address - Street 1:4014 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2205
Practice Address - Country:US
Practice Address - Phone:214-821-6468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-05
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122274122300000X
TX236731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist