Provider Demographics
NPI:1568526192
Name:ANDERSON, CORINNE J (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1677 MOLALLA AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4007
Mailing Address - Country:US
Mailing Address - Phone:503-650-2612
Mailing Address - Fax:503-650-2619
Practice Address - Street 1:3016 SE COURTNEY RD
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-7104
Practice Address - Country:US
Practice Address - Phone:503-659-1055
Practice Address - Fax:503-513-0426
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD88571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice