1477525210 NPI number — DR. THOMAS ALAN CORWIN DDS

Table of content: DR. THOMAS ALAN CORWIN DDS (NPI 1477525210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477525210 NPI number — DR. THOMAS ALAN CORWIN DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORWIN
Provider First Name:
THOMAS
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CORWIN
Provider Other First Name:
TOM
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477525210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2307 NE VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWTON
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73507-2346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-355-5511
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BLDG 6037 BESSINGER RD
Provider Second Line Business Practice Location Address:
ALLEN DENTAL CLINIC
Provider Business Practice Location Address City Name:
FORT SILL
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-442-5223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  4719 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1223P0300X , with the licence number: 36 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)