Healthcare Provider Details

I. General information

NPI: 1225451016
Provider Name (Legal Business Name): BARBARA CORUM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2014
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62968 O B RILEY RD SUITE 12
BEND OR
97701-9442
US

IV. Provider business mailing address

62968 O.B. RILEY RD SUITE 12
BEND OR
97701
US

V. Phone/Fax

Practice location:
  • Phone: 541-330-6445
  • Fax: 541-330-6794
Mailing address:
  • Phone: 541-330-6445
  • Fax: 541-330-6794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH4256
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: