Provider Demographics
NPI:1538504741
Name:GATLIN, CORBIN A (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:A
Last Name:GATLIN
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BURNETT CT
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3100
Mailing Address - Country:US
Mailing Address - Phone:254-399-9925
Mailing Address - Fax:
Practice Address - Street 1:103 BURNETT CT
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3100
Practice Address - Country:US
Practice Address - Phone:254-399-9925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2019-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30580204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery