Provider Demographics
NPI:1629497656
Name:CLOUD, COREY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:JOSEPH
Last Name:CLOUD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COURTENAY PKWY STE 105
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4050
Mailing Address - Country:US
Mailing Address - Phone:321-453-2450
Mailing Address - Fax:
Practice Address - Street 1:500 LENTZ DR STE 40
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-868-9057
Practice Address - Fax:615-868-0234
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR40291223P0221X
FL228791223P0221X
TN106921223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry