1629438221 NPI number — MS. MARIA ZOE SARAH CORKERY DMD

Table of content: MS. MARIA ZOE SARAH CORKERY DMD (NPI 1629438221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629438221 NPI number — MS. MARIA ZOE SARAH CORKERY DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORKERY
Provider First Name:
MARIA ZOE
Provider Middle Name:
SARAH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629438221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/21/2016
NPI Reactivation Date:
11/30/2016

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 CHANNEL DR. STE 300
Provider Second Line Business Mailing Address:
SEARHC
Provider Business Mailing Address City Name:
JUNEAU
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99801
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-463-4041
Provider Business Mailing Address Fax Number:
907-463-4032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 CHANNEL DR. STE 300
Provider Second Line Business Practice Location Address:
SEARHC
Provider Business Practice Location Address City Name:
JUNEAU
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-463-4041
Provider Business Practice Location Address Fax Number:
907-463-4032
Provider Enumeration Date:
02/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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