Provider Demographics
NPI:1255421798
Name:EVANS, CORWIN WINSLOW (DDS)
Entity type:Individual
Prefix:
First Name:CORWIN
Middle Name:WINSLOW
Last Name:EVANS
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 1:54 CRIMSON ROSE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0167
Mailing Address - Country:US
Mailing Address - Phone:949-737-2050
Mailing Address - Fax:949-737-2045
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-759-7007
Practice Address - Fax:949-644-0446
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266271223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics