Provider Demographics
NPI:1477525210
Name:CORWIN, THOMAS ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ALAN
Last Name:CORWIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:CORWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2307 NE VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-2346
Mailing Address - Country:US
Mailing Address - Phone:580-355-5511
Mailing Address - Fax:
Practice Address - Street 1:BLDG 6037 BESSINGER RD
Practice Address - Street 2:ALLEN DENTAL CLINIC
Practice Address - City:FORT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-5223
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK47191223G0001X
OK361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics