Provider Demographics
NPI:1396427795
Name:CORN, LESIA LOUISE (RDH)
Entity type:Individual
Prefix:MRS
First Name:LESIA
Middle Name:LOUISE
Last Name:CORN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LESIA
Other - Middle Name:LOUISE
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:23 WARREN LN
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28739-7393
Mailing Address - Country:US
Mailing Address - Phone:828-606-3377
Mailing Address - Fax:
Practice Address - Street 1:1716 OLD VILLAGE RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3771
Practice Address - Country:US
Practice Address - Phone:828-692-5786
Practice Address - Fax:828-692-8112
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD3364124Q00000X
NC6857124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist