Provider Demographics
NPI:1790920502
Name:TUCKER, CORCINNA LYNN (DENTAL HYGIENE)
Entity Type:Individual
Prefix:
First Name:CORCINNA
Middle Name:LYNN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DENTAL HYGIENE
Other - Prefix:
Other - First Name:CORCINNA
Other - Middle Name:LYNN
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WILSON
Mailing Address - Street 1:74 ECLIPSE CTR
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-3550
Mailing Address - Country:US
Mailing Address - Phone:608-361-6048
Mailing Address - Fax:608-361-6131
Practice Address - Street 1:74 ECLIPSE CTR
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-3550
Practice Address - Country:US
Practice Address - Phone:608-361-6048
Practice Address - Fax:608-361-6131
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5522-16124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist