Healthcare Provider Details

I. General information

NPI: 1306403829
Provider Name (Legal Business Name): SARAH MARIE MCGOWAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 08/26/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 DELWARE ST SE
MINNEAPOLIS MN
55455-0357
US

IV. Provider business mailing address

4000 W 42ND ST
EDINA MN
55416-5004
US

V. Phone/Fax

Practice location:
  • Phone: 612-624-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD14643
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: