Basic Information
| Provider Information | |||||||||
| NPI: | 1225451016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CORUM | ||||||||
| FirstName: | BARBARA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 62968 O.B. RILEY RD | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413306445 | ||||||||
| FaxNumber: | 5413306794 | ||||||||
| Practice Location | |||||||||
| Address1: | 62968 O B RILEY RD | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977019442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413306445 | ||||||||
| FaxNumber: | 5413306794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | H4256 | OR | Y | Dental Providers | Dental Hygienist |
No ID Information.