1538146311 NPI number — COREY LEE PLASTER DDS

Table of content: COREY LEE PLASTER DDS (NPI 1538146311)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538146311 NPI number — COREY LEE PLASTER DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLASTER
Provider First Name:
COREY
Provider Middle Name:
LEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538146311
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 W RIVERSIDE AVE
Provider Second Line Business Mailing Address:
SUITE 810
Provider Business Mailing Address City Name:
SPOKANE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99201-0405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-747-2070
Provider Business Mailing Address Fax Number:
509-624-1485

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 810
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-2070
Provider Business Practice Location Address Fax Number:
509-624-1485
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  9667 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86815 . This is a "WDS PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 1685716 . This is a "UNITED CONCORDIA #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 050613907 5571PL . This is a "ASSURIS PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 5048095 . This is a "DSHS PROVIDER #" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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