DR. COREY MENOU (NPI# 1679014567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679014567 |
| Entity Type | Individual |
| Full Name | DR. COREY MENOU |
| Credential | DDS |
| Practice Address |
1830 E Broad St Ste 104 Mansfield TX 76063-9161 |
| Practice Telephone | 8174737171 |
| Practice Fax Number | 8174732594 |
| Mailing Telephone | 8174737171 |
| Mailing Fax Number | 8174732594 |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2019-12-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
34681 | TX | Dental Providers |
| Street Address |
1830 E BROAD ST STE 104 |
| City | MANSFIELD |
| State | TX |
| Zip Code | 76063-9161 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316558349 | Lindsey Vandyke, D.o. Pllc | Internal Medicine | 3150 E Broad Street, Ste 100, Mansfield, TX 76063 | 2020-08-13 |
| 1942819867 | Jennifer Que Chau Nguyen | Pharmacist | 980 U.S. 287 Frontage Rd #287, Mansfield, TX 76063 | 2020-07-27 |
| 1194346890 | Ana Maria Gonzalez | Dentist | 1600 Us Highway 287, Suite 102, Mansfield, TX 76063 | 2020-05-04 |
| 1245869080 | Stateserv Medical of Texas, LLC | Durable Medical Equipment & Medical Supplies | 7941 Rodeo Trail, Mansfield, TX 76063 | 2020-04-03 |
| 1649802232 | Mary Puanani Kamai | Nurse Practitioner | 1301 E. Debbie Lane, Suite 102 #1405, Mansfield, TX 76063 | 2020-02-11 |
| 1770123028 | Gladys Vera Nfodzo | Nurse Practitioner | 901 W. Broad St, Mansfield, TX 76063 | 2020-01-14 |
| 1669011300 | Alexa Smith | Nurse Practitioner | 2800 E Broad St #304, Mansfield, TX 76063 | 2019-12-28 |
| 1477190437 | Mel Rockwall LLC | Optometrist | 1701 East Broad Street, Ste 109, Mansfield, TX 76063 | 2019-12-09 |
| 1376185512 | Daniel Max & Marcandrea LLC | Optometrist | 1701 East Broad St., Ste 109, Mansfield, TX 76063 | 2019-10-09 |
| 1861046385 | Lacey Eaton | Counselor | 805 Killian Dr, Mansfield, TX 76063 | 2019-08-01 |
| Find all providers in zip 76063 | ||||
| Taxonomy Code | 1223P0221X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Pediatric Dentistry |
| An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518353184 | Elias E Chahine | Dentist | 1756 Broad Park Cir S #100, Mansfield, TX 76063 | 2015-04-10 |
| 1508133224 | Pediatric Dentristry of Mansfield,pllc | Dentist | 1830 E Broad St, Ste104, Mansfield, TX 76063-9162 | 2011-11-23 |
| 1396901922 | Daniel E Wright | Dentist | 1830 E. Broad St., Suite 104, Mansfield, TX 76063-2874 | 2008-08-04 |
| 1811106909 | Heather Ann Gregg | Dentist | 245 Sterkle Blvd, Suite 101, Mansfield, OH 44907 | 2007-05-22 |
| 1972649143 | Deborah C. Sullivan | Dentist | 1200 U.S. Hwy 287 North, Suite 102, Mansfield, TX 76063 | 2007-01-29 |
| 1699853051 | Timothy J Iten | Dentist | 1 Marion Ave Ste 201, Mansfield, OH 44903-7905 | 2006-11-02 |
| 1487740114 | Jackson Cockley | Dentist | 1145 Aspira Ct, Mansfield, OH 44906-4125 | 2006-10-04 |
| 1356328041 | Randolph W Hamilton IIi | Dentist | 1759 Broad Park Cir S, Mansfield, TX 76063 | 2005-12-23 |
| 1285921825 | Blane Reynolds Hamilton | Dentist | 1759 Broad Park Cir S, Ste 205, Mansfield, TX 76063-7833 | 2011-07-04 |
| 1669779328 | Hyde,bailey,miller-south Partnership | Dentist | 2300 Matlock Rd, Suite 28, Mansfield, TX 76063-5019 | 2011-02-16 |
| Find all providers in MANSFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.