Basic Information
| Provider Information | |||||||||
| NPI: | 1750930970 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORCORAN | ||||||||
| FirstName: | JENNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2553 PUU HAPAPA LOOP | ||||||||
| Address2: | |||||||||
| City: | WAHIAWA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967867046 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | BLDG 660 MCCORNACK ROAD | ||||||||
| Address2: | |||||||||
| City: | SCHOFIELD BARRACKS | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084336825 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2019 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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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 | DH011385 | GA | Y | Dental Providers | Dental Hygienist |
No ID Information.