Healthcare Provider Details

I. General information

NPI: 1285783605
Provider Name (Legal Business Name): GARETH THOMAS COWARD LD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CENTER STREET SUITE 109 AUBURN DENTURE CENTER CENTER STREET PLAZA
AUBURN ME
04210
US

IV. Provider business mailing address

120 CENTER STREET SUITE 109 AUBURN DENTURE CENTER CENTER STREET PLAZA
AUBURN ME
04210
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-1149
  • Fax: 207-777-1099
Mailing address:
  • Phone: 207-777-1149
  • Fax: 207-777-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122400000X
TaxonomyDenturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: