MEDICARE: CHARLES T CORWIN D.D.S.,M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	7440	TX

General Provider Information

NPI Number	:	1336146687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES T CORWIN D.D.S.,M.S.

Provider Business Mailing Address
First Line	:	1005 N MECHANIC ST
Second Line	:	P.O. BOX 549
City	:	EL CAMPO
State	:	TX
Zip	:	77437-3027
Country	:	US
Telephone Number	:	979-543-2411
Fax Number	:	979-543-2541

Provider Business Practice Location Address
First Line	:	1005 N MECHANIC ST
Second Line	:
City	:	EL CAMPO
State	:	TX
Zip	:	77437-3027
Country	:	US
Telephone Number	:	979-543-2411
Fax Number	:	979-543-2541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	05/01/2008

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