Provider Demographics
NPI:1598980583
Name:CORWIN FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CORWIN FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OWEN
Authorized Official - Last Name:CORWIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-367-3290
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4993122300000X
OK5011122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty