Provider Demographics
NPI:1538203575
Name:MELIN, KORY M (DMD)
Entity type:Individual
Prefix:DR
First Name:KORY
Middle Name:M
Last Name:MELIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 E 15TH AVENUE CT
Mailing Address - Street 2:
Mailing Address - City:COAL VALLEY
Mailing Address - State:IL
Mailing Address - Zip Code:61240-9154
Mailing Address - Country:US
Mailing Address - Phone:309-799-7370
Mailing Address - Fax:
Practice Address - Street 1:2909 19TH STREET
Practice Address - Street 2:
Practice Address - City:EAST MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61244
Practice Address - Country:US
Practice Address - Phone:309-796-2251
Practice Address - Fax:309-796-2274
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0239721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice