Provider Demographics
NPI:1851877674
Name:CORRERA, AMBER M (IPDH)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:CORRERA
Suffix:
Gender:
Credentials:IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 DONICA RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1619
Mailing Address - Country:US
Mailing Address - Phone:617-420-2338
Mailing Address - Fax:
Practice Address - Street 1:276 US ROUTE 1 UNIT B
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1629
Practice Address - Country:US
Practice Address - Phone:617-420-2338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000906047124Q00000X
MERDH4531124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist