Healthcare Provider Details

I. General information

NPI: 1851146658
Provider Name (Legal Business Name): CAITLYN CORLEY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 JEFFERSON ST
MANSFIELD LA
71052-2600
US

IV. Provider business mailing address

3926 PROSPECT RD
FLORIEN LA
71429-4704
US

V. Phone/Fax

Practice location:
  • Phone: 318-872-1557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7528
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7528
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: