Provider Demographics
NPI:1487872610
Name:PRICE, CORY DAVID (DDS)
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:DAVID
Last Name:PRICE
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 1:5991 SOUTH 3500 WEST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-6701
Mailing Address - Country:US
Mailing Address - Phone:801-985-1669
Mailing Address - Fax:
Practice Address - Street 1:5991 SOUTH 3500 WEST PRICE ORTHODONTICS
Practice Address - Street 2:SUITE 200
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-6701
Practice Address - Country:US
Practice Address - Phone:801-985-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328504-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics