Provider Demographics
NPI:1922299247
Name:NAIMAN, CORY MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:MICHAEL
Last Name:NAIMAN
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 1:1224 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-2927
Mailing Address - Country:US
Mailing Address - Phone:307-333-6285
Mailing Address - Fax:
Practice Address - Street 1:1224 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-2927
Practice Address - Country:US
Practice Address - Phone:307-333-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9473122300000X
WY12831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice