Provider Demographics
NPI:1538105689
Name:CORBETT, GWENDOLYN D (DDS)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:D
Last Name:CORBETT
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 1:9804 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-6442
Mailing Address - Country:US
Mailing Address - Phone:225-766-3061
Mailing Address - Fax:225-766-3199
Practice Address - Street 1:9804 BLUEBONNET BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-6442
Practice Address - Country:US
Practice Address - Phone:225-766-3061
Practice Address - Fax:225-766-3199
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA50941223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics