Provider Demographics
NPI:1780067603
Name:TRUMAN, COREY (DMD)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:
Last Name:TRUMAN
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 1:1025 ASHLEY ST
Mailing Address - Street 2:STE A
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-3406
Mailing Address - Country:US
Mailing Address - Phone:270-793-0703
Mailing Address - Fax:270-793-0740
Practice Address - Street 1:1025 ASHLEY ST
Practice Address - Street 2:STE A
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-3406
Practice Address - Country:US
Practice Address - Phone:270-793-0703
Practice Address - Fax:270-793-0740
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist