Healthcare Provider Details

I. General information

NPI: 1811040371
Provider Name (Legal Business Name): CORLISS JEAN FURBERT DDS, MPH,PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 BARRETT DR SUITE 103
RALEIGH NC
27609-6611
US

IV. Provider business mailing address

12309 STAUNTON CT
RALEIGH NC
27613-6831
US

V. Phone/Fax

Practice location:
  • Phone: 919-900-8235
  • Fax: 919-900-8237
Mailing address:
  • Phone: 919-676-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number06907
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: