Provider Demographics
NPI:1245788777
Name:SWIHART, CORRIE JEAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:JEAN
Last Name:SWIHART
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12725 MCMANUS BLVD BLDG 1
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-4402
Mailing Address - Country:US
Mailing Address - Phone:757-874-0990
Mailing Address - Fax:
Practice Address - Street 1:12725 MCMANUS BLVD STE 1B
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4402
Practice Address - Country:US
Practice Address - Phone:757-874-0990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012490A122300000X
VA04014160331223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist