Provider Demographics
NPI:1780833228
Name:CUSHEN-CORKER, SARRA ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARRA
Middle Name:ELIZABETH
Last Name:CUSHEN-CORKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SARRA
Other - Middle Name:ELIZABETH
Other - Last Name:CUSHEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:15301 WARREN SHINGLE ROAD
Mailing Address - Street 2:
Mailing Address - City:BEALE AFB
Mailing Address - State:CA
Mailing Address - Zip Code:95903-1907
Mailing Address - Country:US
Mailing Address - Phone:530-634-4891
Mailing Address - Fax:
Practice Address - Street 1:15301 WARREN SHINGLE ROAD
Practice Address - Street 2:
Practice Address - City:BEALE AFB
Practice Address - State:CA
Practice Address - Zip Code:95903-1907
Practice Address - Country:US
Practice Address - Phone:530-634-4662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95311223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No1223G0001XDental ProvidersDentistGeneral Practice