Active NPI
Marquita Corliss
- Dental Hygienist
- Springfield, OR
National Provider Identifier
1548368160
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- H1773
- Practice address
- 2073 Olympic Street
Springfield, OR 97477-3413 - Phone
- (541) 682-3550
- Fax
- (541) 682-3551
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | H1773 | OR | Primary |
Addresses
Primary practice location
2073 Olympic Street
Springfield, OR 97477-3413
Mailing address
2073 Olympic Street
Springfield, OR 97477-3413
Phone (541) 682-3550
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 181569 | Medicaid | OR | |
| 227622 | Medicaid | OR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H1773 | OR | MD | Dental Hygienist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303862400000",
"number": "1548368160",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2073 OLYMPIC STREET",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974773413",
"telephone_number": "541-682-3550",
"fax_number": "541-682-3551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2073 OLYMPIC STREET",
"city": "SPRINGFIELD",
"state": "OR",
"postal_code": "974773413",
"telephone_number": "541-682-3550",
"fax_number": "541-682-3551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORLISS",
"first_name": "MARQUITA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-20",
"last_updated": "2011-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "OR",
"license": "H1773",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "181569",
"state": "OR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "227622",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.