Provider Demographics
NPI:1538146311
Name:PLASTER, COREY LEE (DDS)
Entity type:Individual
Prefix:
First Name:COREY
Middle Name:LEE
Last Name:PLASTER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W RIVERSIDE AVE
Mailing Address - Street 2:SUITE 810
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0405
Mailing Address - Country:US
Mailing Address - Phone:509-747-2070
Mailing Address - Fax:509-624-1485
Practice Address - Street 1:421 W RIVERSIDE AVE
Practice Address - Street 2:SUITE 810
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-0405
Practice Address - Country:US
Practice Address - Phone:509-747-2070
Practice Address - Fax:509-624-1485
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA96671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA86815OtherWDS PROVIDER #
WA1685716OtherUNITED CONCORDIA #
WA050613907 5571PLOtherASSURIS PROVIDER #
WA5048095OtherDSHS PROVIDER #