Provider Demographics
NPI:1639273352
Name:THOMPSON, CORINNE
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIT 26610
Mailing Address - Street 2:
Mailing Address - City:APO AE
Mailing Address - State:NY
Mailing Address - Zip Code:09244
Mailing Address - Country:US
Mailing Address - Phone:951-300-1720
Mailing Address - Fax:
Practice Address - Street 1:UNIT 26610
Practice Address - Street 2:WUERBERG DENTAL ACTIVITY CREDENTIALS OFFICE
Practice Address - City:APO AE
Practice Address - State:NY
Practice Address - Zip Code:09244-6610
Practice Address - Country:US
Practice Address - Phone:951-300-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH10969124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist