Healthcare Provider Details

I. General information

NPI: 1821046624
Provider Name (Legal Business Name): JOHN MCDOWELL D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 URSULA ST ROOM 5200
AURORA CO
80010-7402
US

IV. Provider business mailing address

MAIL STOP F742 PO BOX 6510
AURORA CO
80045
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-0687
  • Fax: 720-848-0660
Mailing address:
  • Phone: 720-848-0689
  • Fax: 720-848-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number6893
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: