Healthcare Provider Details

I. General information

NPI: 1255421798
Provider Name (Legal Business Name): CORWIN WINSLOW EVANS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 AVOCADO AVE SUITE 309
NEWPORT BEACH CA
92660-7720
US

IV. Provider business mailing address

54 CRIMSON ROSE
IRVINE CA
92603-0167
US

V. Phone/Fax

Practice location:
  • Phone: 949-759-7007
  • Fax: 949-644-0446
Mailing address:
  • Phone: 949-737-2050
  • Fax: 949-737-2045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number26627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: