Healthcare Provider Details

I. General information

NPI: 1669037529
Provider Name (Legal Business Name): HANNAH MARIE CORCORAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2019
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14590 STATE ROUTE 93
JACKSON OH
45640-8977
US

IV. Provider business mailing address

941 MARKET ST
PIKETON OH
45661-9757
US

V. Phone/Fax

Practice location:
  • Phone: 740-286-2826
  • Fax: 740-288-1874
Mailing address:
  • Phone: 740-289-2371
  • Fax: 740-289-4291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025724
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: