Provider Demographics
NPI:1770073322
Name:CORRIN, LUCY HELEN-NEVANEN (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:HELEN-NEVANEN
Last Name:CORRIN
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 1:50631 NEWBURG LN
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MN
Mailing Address - Zip Code:56628-4176
Mailing Address - Country:US
Mailing Address - Phone:218-280-7915
Mailing Address - Fax:
Practice Address - Street 1:303 MAIN AVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MN
Practice Address - Zip Code:56628
Practice Address - Country:US
Practice Address - Phone:218-743-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist