Provider Demographics
NPI:1831459577
Name:DECOTEAU, COREY FREDRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:FREDRICK
Last Name:DECOTEAU
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:39 SIMON STREET
Mailing Address - Street 2:UNIT 11-13
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-883-4008
Mailing Address - Fax:603-881-3822
Practice Address - Street 1:39 SIMON STREET
Practice Address - Street 2:UNIT 11-13
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-883-4008
Practice Address - Fax:603-881-3822
Is Sole Proprietor?:No
Enumeration Date:2012-05-28
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559571223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery