Provider Demographics
NPI:1487752408
Name:STITH, COREY THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:THOMAS
Last Name:STITH
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 1:156 YELLOW JACKET DR
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1018
Mailing Address - Country:US
Mailing Address - Phone:859-873-7616
Mailing Address - Fax:
Practice Address - Street 1:156 YELLOW JACKET DR
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1018
Practice Address - Country:US
Practice Address - Phone:859-873-7616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 71071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice