Provider Demographics
NPI:1205869484
Name:HASENAUER, COREY BRUCE (DDS)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:BRUCE
Last Name:HASENAUER
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 1:850 E HARVARD AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-5073
Mailing Address - Country:US
Mailing Address - Phone:303-471-0346
Mailing Address - Fax:720-344-3581
Practice Address - Street 1:850 E HARVARD AVE
Practice Address - Street 2:SUITE 121
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5073
Practice Address - Country:US
Practice Address - Phone:303-471-0346
Practice Address - Fax:720-344-4581
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist