Provider Demographics
NPI:1780316083
Name:CORWIN D MARTIN
Entity type:Organization
Organization Name:CORWIN D MARTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CORWIN
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-551-0581
Mailing Address - Street 1:9450 E IRONWOOD SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4570
Mailing Address - Country:US
Mailing Address - Phone:480-551-0581
Mailing Address - Fax:480-551-0585
Practice Address - Street 1:9450 E IRONWOOD SQUARE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4570
Practice Address - Country:US
Practice Address - Phone:480-551-0581
Practice Address - Fax:480-551-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty