Provider Demographics
NPI:1942653605
Name:WURMAN, CORY (DDS)
Entity type:Individual
Prefix:DR
First Name:CORY
Middle Name:
Last Name:WURMAN
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 1:9550 W SAHARA AVE
Mailing Address - Street 2:APARTMENT 1024
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5373
Mailing Address - Country:US
Mailing Address - Phone:702-626-7606
Mailing Address - Fax:
Practice Address - Street 1:9550 W SAHARA AVE
Practice Address - Street 2:APARTMENT 1024
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5373
Practice Address - Country:US
Practice Address - Phone:702-626-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL-425-161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice