Healthcare Provider Details

I. General information

NPI: 1568627578
Provider Name (Legal Business Name): SARAH JEAN MOWERY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARAH JEAN WILSON D.D.S.

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MAIN ST
ANTWERP OH
45813-9587
US

IV. Provider business mailing address

301 S MAIN ST # 1071
ANTWERP OH
45813-9587
US

V. Phone/Fax

Practice location:
  • Phone: 419-258-6511
  • Fax: 419-715-0880
Mailing address:
  • Phone: 419-258-6511
  • Fax: 419-715-0880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12011191A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: