Healthcare Provider Details

I. General information

NPI: 1144161217
Provider Name (Legal Business Name): CORRINE ELISE MOLTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3780 W JONATHAN MOORE PIKE STE 180
COLUMBUS IN
47201-9430
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40202-1701
US

V. Phone/Fax

Practice location:
  • Phone: 812-342-9666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12015044A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: