Healthcare Provider Details

I. General information

NPI: 1689995367
Provider Name (Legal Business Name): RICHARD GANON ROWAN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 W 25TH ST
MERCED CA
95340-2814
US

IV. Provider business mailing address

631 W 25TH ST
MERCED CA
95340-2814
US

V. Phone/Fax

Practice location:
  • Phone: 209-383-1181
  • Fax: 209-383-0248
Mailing address:
  • Phone: 209-383-1181
  • Fax: 209-383-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number52680
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: