Healthcare Provider Details

I. General information

NPI: 1598095705
Provider Name (Legal Business Name): ROBERT CHAD ROWAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2010
Last Update Date: 01/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

564 W 25TH ST
MERCED CA
95340-2828
US

IV. Provider business mailing address

564 W 25TH ST
MERCED CA
95340-2828
US

V. Phone/Fax

Practice location:
  • Phone: 209-723-6709
  • Fax:
Mailing address:
  • Phone: 209-723-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number59040
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: