Healthcare Provider Details

I. General information

NPI: 1124133061
Provider Name (Legal Business Name): LESTER LYMAN COWDEN III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 W BRITTON RD SUITE A
OKLAHOMA CITY OK
73120-2036
US

IV. Provider business mailing address

3100 W BRITTON RD SUITE A
OKLAHOMA CITY OK
73120-2036
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-3312
  • Fax: 405-751-3524
Mailing address:
  • Phone: 405-751-3312
  • Fax: 405-751-3524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number4687
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: