MEDICARE: DR. MICHAEL DENNIS IRWIN DMD

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	2808	AL

General Provider Information

NPI Number	:	1467532135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL DENNIS IRWIN DMD

Provider Business Mailing Address
First Line	:	4162 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3606
Country	:	US
Telephone Number	:	334-279-6910
Fax Number	:	334-279-6983

Provider Business Practice Location Address
First Line	:	4162 LOMAC ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36106-3606
Country	:	US
Telephone Number	:	334-279-6910
Fax Number	:	334-279-6983

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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