Individual
CORLISS KELLY HALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
15182 N. 75TH AVE, PEORIA, AZ 85381
(623) 878-2400
Mailing address
15182 N. 75TH AVE., PEORIA, AZ 85381
(623) 878-2400
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
H3927
OR
124Q00000X
Dental Hygienist
Primary
H6119
AZ
Other
Enumeration date
01/19/2012
Last updated
01/19/2012
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