Provider Demographics
NPI:1124163878
Name:IRVIN, ALAN WATSON (DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WATSON
Last Name:IRVIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1515 W CORNWALLIS DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-6338
Mailing Address - Country:US
Mailing Address - Phone:336-379-1134
Mailing Address - Fax:336-379-1119
Practice Address - Street 1:1515 W CORNWALLIS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-6338
Practice Address - Country:US
Practice Address - Phone:336-379-1134
Practice Address - Fax:336-379-1119
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC50231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics