Healthcare Provider Details

I. General information

NPI: 1750362083
Provider Name (Legal Business Name): WINTON BENNETT COWLES D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5920 GRELOT RD
MOBILE AL
36609-3606
US

IV. Provider business mailing address

5920 GRELOT RD
MOBILE AL
36609-3606
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5974
  • Fax: 251-343-0431
Mailing address:
  • Phone: 251-343-5974
  • Fax: 251-343-0431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3092
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: