Individual
KORY WALLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1100 KEN PRATT BLVD STE E, LONGMONT, CO 80501-6380
(720) 458-6684
Mailing address
1100 KEN PRATT BLVD UNIT E, LONGMONT, CO 80501
(720) 505-9422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
10742
CO
Other
Enumeration date
07/10/2012
Last updated
02/17/2023
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