Corliss, Marquita
Corliss, Marquita is an individual health care provider with primary practice located at 2073 Olympic Street , Springfield OR 97477-3413. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Corliss, Marquita can be contacted via phone (541) 682-3550.Contact Information
Primary practice address
2073 Olympic Street
Springfield OR 97477-3413
Phone: (541) 682-3550
Fax: (541) 682-3551
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dental Hygienist | 124Q00000X | H1773 | Oregon |
Profile Details
| NPI number | 1548368160 |
|---|---|
| LBN Legal business name | Corliss, Marquita |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 20th, 2006 |
| Last updated | Apr 27th, 2011 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1548368160 | NPPES |
| Oregon | MEDICAID | 181569 | |
| Oregon | MEDICAID | 227622 |
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