Individual
COREY MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
1217 EAST MAIN, LINN, MO 65051
(573) 897-2388
(573) 897-3816
Mailing address
PO BOX 1219, 1217 EAST MAIN ST, LINN, MO 65051
(573) 897-2388
(573) 897-3816
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
13-2006
NM
1223G0001X
General Practice Dentistry
Primary
2006016427
MO
Other
Enumeration date
02/06/2007
Last updated
11/29/2023
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