Healthcare Provider Details

I. General information

NPI: 1598774036
Provider Name (Legal Business Name): JOHN C DOWELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

772 NATIONAL HIGHWAY
LAVALE MD
21502
US

IV. Provider business mailing address

772 NATIONAL HIGHWAY
LAVALE MD
21502
US

V. Phone/Fax

Practice location:
  • Phone: 301-729-6911
  • Fax: 301-729-6912
Mailing address:
  • Phone: 301-729-6911
  • Fax: 301-729-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number6402
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: