Provider Demographics
NPI:1477630655
Name:CORRELL, MARY B (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:B
Last Name:CORRELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1625 W FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-6800
Mailing Address - Country:US
Mailing Address - Phone:509-326-2621
Mailing Address - Fax:509-325-5796
Practice Address - Street 1:6821 N COUNTRY HOMES BLVD
Practice Address - Street 2:SRE.#202
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-4372
Practice Address - Country:US
Practice Address - Phone:509-326-2621
Practice Address - Fax:509-325-5796
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007564122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist