Provider Demographics
NPI:1548676349
Name:CORNELIUS, LINSEY LORA (DMD)
Entity type:Individual
Prefix:DR
First Name:LINSEY
Middle Name:LORA
Last Name:CORNELIUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 IVAL JAMES BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-8174
Mailing Address - Country:US
Mailing Address - Phone:859-626-9620
Mailing Address - Fax:
Practice Address - Street 1:1012 IVAL JAMES BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-8174
Practice Address - Country:US
Practice Address - Phone:859-626-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9459122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist