Provider Demographics
NPI:1013655109
Name:YOSHIMURA, CORRIE CHEN-TING (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORRIE
Middle Name:CHEN-TING
Last Name:YOSHIMURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 NW LOIS LN
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-8356
Mailing Address - Country:US
Mailing Address - Phone:808-342-1173
Mailing Address - Fax:
Practice Address - Street 1:3219 8TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1036
Practice Address - Country:US
Practice Address - Phone:515-412-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE78471223G0001X
IADDS-100661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice