Jessica Lillie Corcoran, D.D.S.
Individual provider Active NPI General Practice Dentistry · Waverly, IA
NPI 1093844573 · NPPES record last updated May 1, 2020
Key facts
- NPI
- 1093844573
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 08339 (IA)
- Practice address
- 121 20TH St NW
Waverly, IA 50677 - Phone
- (319) 352-5281
- Fax
- (319) 352-0509
- NPI assigned
- Mar 2, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08339 | IA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walsworth Family Dentistry, P.C. | General Practice | Current |
Accepting new patients |
| Louscher Family Dentistry | General Practice | Past | Accepting new patients |
Locations
121 20th St NW
Waverly, IA 50677
Phone (319) 352-5281
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 08339 | IA | Yes |
Addresses
Primary practice location
121 20TH St NW
Waverly, IA 50677
Mailing address
121 20TH St NW
Waverly, IA 50677
Phone (319) 352-5281
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1728550 | Medicaid | IA | |
| 0728550 | Medicaid | IA |
Other names
- Jessica Lillie Ewoldt
Other providers in Waverly, IA
- Ashley Clinton
- Tricia Jane Coleman-Waterbury
- College Hill Drug Co.
- James Ross Cone
- Amanda Cook
- Sara Nicole Corcoran
- County of Bremer
- County of Bremer
- County of Bremer
- Julie Marie Cousin
All providers in Waverly, IA · General Practice Dentistry in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 1, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.