Individual
DR. KORY LEE BUMGARDNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DENTIST
Contact information
Practice address
2217 W 12TH ST, SUITE #3, HASTINGS, NE 68901-3660
(402) 462-6484
(402) 462-2444
Mailing address
2217 W 12TH ST, SUITE #3, HASTINGS, NE 68901-3660
(402) 462-6484
(402) 462-2444
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6316
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47-0841441-00
—
NE
Enumeration date
08/21/2006
Last updated
07/08/2007
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