Provider Demographics
NPI:1548207376
Name:CORWIN, DEBORAH A (DDS)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:CORWIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:OK
Mailing Address - Zip Code:74010-2503
Mailing Address - Country:US
Mailing Address - Phone:918-367-3290
Mailing Address - Fax:
Practice Address - Street 1:221 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:OK
Practice Address - Zip Code:74010-2503
Practice Address - Country:US
Practice Address - Phone:918-367-3290
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK50111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice