Provider Demographics
NPI:1558504753
Name:CORWIN, CALEB LLOYD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:LLOYD
Last Name:CORWIN
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 1:3535 RANDOLPH RD
Mailing Address - Street 2:SUITE 103-R
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1086
Mailing Address - Country:US
Mailing Address - Phone:704-365-0123
Mailing Address - Fax:704-364-8640
Practice Address - Street 1:3535 RANDOLPH RD
Practice Address - Street 2:SUITE 103-R
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1086
Practice Address - Country:US
Practice Address - Phone:704-365-0123
Practice Address - Fax:704-364-8640
Is Sole Proprietor?:No
Enumeration Date:2009-04-17
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist