Provider Demographics
NPI:1336146687
Name:CORWIN, CHARLES T (DDS,MS)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:T
Last Name:CORWIN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N MECHANIC ST
Mailing Address - Street 2:P.O. BOX 549
Mailing Address - City:EL CAMPO
Mailing Address - State:TX
Mailing Address - Zip Code:77437-3027
Mailing Address - Country:US
Mailing Address - Phone:979-543-2411
Mailing Address - Fax:979-543-2541
Practice Address - Street 1:1005 N MECHANIC ST
Practice Address - Street 2:
Practice Address - City:EL CAMPO
Practice Address - State:TX
Practice Address - Zip Code:77437-3027
Practice Address - Country:US
Practice Address - Phone:979-543-2411
Practice Address - Fax:979-543-2541
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics