Healthcare Provider Details

I. General information

NPI: 1780316083
Provider Name (Legal Business Name): CORWIN D MARTIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9450 E IRONWOOD SQUARE DR
SCOTTSDALE AZ
85258-4570
US

IV. Provider business mailing address

9450 E IRONWOOD SQUARE DR
SCOTTSDALE AZ
85258-4570
US

V. Phone/Fax

Practice location:
  • Phone: 480-551-0581
  • Fax: 480-551-0585
Mailing address:
  • Phone: 480-551-0581
  • Fax: 480-551-0585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. CORWIN DEAN MARTIN
Title or Position: OWNER/DOCTOR
Credential: MD
Phone: 480-551-0581