Healthcare Provider Details

I. General information

NPI: 1225142227
Provider Name (Legal Business Name): CHARLES MICHAEL COWLEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E 5TH ST
TUSCUMBIA AL
35674
US

IV. Provider business mailing address

121 E 5TH ST
TUSCUMBIA AL
35674
US

V. Phone/Fax

Practice location:
  • Phone: 256-383-2182
  • Fax: 256-383-4990
Mailing address:
  • Phone: 256-383-2182
  • Fax: 256-383-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3723
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: