Healthcare Provider Details

I. General information

NPI: 1548207376
Provider Name (Legal Business Name): DEBORAH A. CORWIN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E 7TH AVE
BRISTOW OK
74010-2503
US

IV. Provider business mailing address

221 E 7TH AVE
BRISTOW OK
74010-2503
US

V. Phone/Fax

Practice location:
  • Phone: 918-367-3290
  • Fax:
Mailing address:
  • Phone: 918-367-3290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5011
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: