Corliss Kelly Hales, RDH

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

H6119 Issued in AZ

Practice address

15182 N. 75TH Ave
Peoria, AZ 85381

Phone

(623) 878-2400

NPI assigned

Jan 19, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Corliss Kelly Putignano Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1326931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326931200000",
    "number": "1578834792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15182 N. 75TH AVE.",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85381",
            "telephone_number": "623-878-2400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15182 N. 75TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "85381",
            "telephone_number": "623-878-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALES",
        "first_name": "CORLISS",
        "middle_name": "KELLY",
        "credential": "RDH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-19",
        "last_updated": "2012-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "AZ",
            "license": "H6119",
            "primary": true
        },
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "OR",
            "license": "H3927",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORLISS",
            "last_name": "PUTIGNANO",
            "middle_name": "KELLY",
            "credential": "RDH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Tesfay Mezgebe Hailu
• Marci Haines, PSYD
• Anthony Hairapetian, M.A.
• Adugna Busa Haji
• Georgette Fabiola Hakizimana
• Half Dental Inc
• Brent Robert Hall, DDS
• John Lucas Hall Jr., LPN
• Daron Guy Halle, D.C.
• Kelly Jean Halterman, AU.D.

• Dental Hygienist in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Dental Hygienist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.