Provider Demographics
NPI:1245476167
Name:CORLISS, DOROTHY LEA (RDH)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:LEA
Last Name:CORLISS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8604 112TH ST E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-3857
Mailing Address - Country:US
Mailing Address - Phone:253-845-0558
Mailing Address - Fax:
Practice Address - Street 1:8604 112TH ST E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3857
Practice Address - Country:US
Practice Address - Phone:253-845-0558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00000980124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist