Provider Demographics
NPI:1700229226
Name:MIHAILOVICH, COREY ANDREW (DMD)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:ANDREW
Last Name:MIHAILOVICH
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 1:2423 CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-3848
Mailing Address - Country:US
Mailing Address - Phone:406-494-7033
Mailing Address - Fax:406-494-8256
Practice Address - Street 1:2423 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-3848
Practice Address - Country:US
Practice Address - Phone:406-494-7033
Practice Address - Fax:406-494-8256
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK15071223G0001X
MT59651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice