Provider Demographics
NPI:1053046243
Name:CORBITT, DEMETRIA JILL (RDH)
Entity type:Individual
Prefix:MRS
First Name:DEMETRIA
Middle Name:JILL
Last Name:CORBITT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 HIGHWAY 104
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-9182
Mailing Address - Country:US
Mailing Address - Phone:501-831-2852
Mailing Address - Fax:
Practice Address - Street 1:1242 W 42ND AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-7109
Practice Address - Country:US
Practice Address - Phone:870-535-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1111124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist