Healthcare Provider Details

I. General information

NPI: 1982647574
Provider Name (Legal Business Name): JAMES O CORWIN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 04/13/2015
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 Number4993
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: