Provider Demographics
NPI:1538563457
Name:CORREA, CORINE L (RDH, BSHS)
Entity type:Individual
Prefix:MRS
First Name:CORINE
Middle Name:L
Last Name:CORREA
Suffix:
Gender:F
Credentials:RDH, BSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 WILD BUFFALO DR
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4681
Mailing Address - Country:US
Mailing Address - Phone:512-694-5362
Mailing Address - Fax:
Practice Address - Street 1:2600 S 1ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7435
Practice Address - Country:US
Practice Address - Phone:254-298-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-21
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9131124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist