Healthcare Provider Details

I. General information

NPI: 1730312463
Provider Name (Legal Business Name): SARAH J MOWERY DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SOUTH CLEVELAND STREET
ANTWERP OH
45813
US

IV. Provider business mailing address

302 S CLEVELAND STREET
ANTWERP OH
45813
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30023101
License Number StateOH

VIII. Authorized Official

Name: SARAH J MOWERY
Title or Position: OWNER
Credential: DDS
Phone: 765-617-3308