Provider Demographics
NPI:1134639578
Name:CORBIN, JUDITH CROCKER (RDH, BSDH, FADPD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:CROCKER
Last Name:CORBIN
Suffix:
Gender:F
Credentials:RDH, BSDH, FADPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5437 US HIGHWAY 19 S
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-1219
Mailing Address - Country:US
Mailing Address - Phone:229-403-0227
Mailing Address - Fax:
Practice Address - Street 1:1255 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344-1128
Practice Address - Country:US
Practice Address - Phone:850-342-0170
Practice Address - Fax:850-342-0024
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH009161124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist