Provider Demographics
NPI:1639290216
Name:COREY, ALLAN B
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:B
Last Name:COREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1372 W ROBINHOOD DR
Mailing Address - Street 2:STE B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207
Mailing Address - Country:US
Mailing Address - Phone:209-951-3703
Mailing Address - Fax:209-951-1964
Practice Address - Street 1:1372 W ROBINHOOD DR
Practice Address - Street 2:STE B
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207
Practice Address - Country:US
Practice Address - Phone:209-951-3703
Practice Address - Fax:209-951-1964
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA032818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist