Organization
KIM P. KORNEGAY, DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIM PIERSON KORNEGAY DMD (OWNER)
(334) 285-7111
Entity
Organization
Contact information
Practice address
711 KORNEGAY DR, SUITE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
(334) 285-3310
Mailing address
711 KORNEGAY DR, SUITE A, PRATTVILLE, AL 36066-7715
(334) 285-7111
(334) 285-3310
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
CS3863
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
776896
UNITED CONCORIA
AL
01
—
90076
BLUECROSSBLUESHIELD OF AL
AL
Enumeration date
04/11/2008
Last updated
04/11/2008
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