Provider Demographics
NPI:1245455575
Name:HACKER, CORRINE HARRIET (DMD)
Entity type:Individual
Prefix:DR
First Name:CORRINE
Middle Name:HARRIET
Last Name:HACKER
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 1:4316 SEDGE CT
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-8520
Mailing Address - Country:US
Mailing Address - Phone:317-769-4048
Mailing Address - Fax:
Practice Address - Street 1:4316 SEDGE CT
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8520
Practice Address - Country:US
Practice Address - Phone:317-769-4048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010710A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist