Provider Demographics
NPI:1457764094
Name:CORKERN, MARCUS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:CORKERN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17029 N LAKEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-8960
Mailing Address - Country:US
Mailing Address - Phone:225-328-9361
Mailing Address - Fax:
Practice Address - Street 1:17029 N LAKEWAY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-8960
Practice Address - Country:US
Practice Address - Phone:225-328-9361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice