Provider Demographics
NPI:1356497440
Name:ERWIN, TRENT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:M
Last Name:ERWIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 LAWSON PARK WAY
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-6969
Mailing Address - Country:US
Mailing Address - Phone:936-554-7810
Mailing Address - Fax:
Practice Address - Street 1:1101 RAGUET ST
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4059
Practice Address - Country:US
Practice Address - Phone:936-560-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice