Individual
MARQUITA CORLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2073 OLYMPIC STREET, SPRINGFIELD, OR 97477-3413
(541) 682-3550
(541) 682-3551
Mailing address
2073 OLYMPIC STREET, SPRINGFIELD, OR 97477-3413
(541) 682-3550
(541) 682-3551
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H1773
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181569
—
OR
05
—
227622
—
OR
Enumeration date
09/20/2006
Last updated
04/27/2011
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