Healthcare Provider Details

I. General information

NPI: 1124549050
Provider Name (Legal Business Name): ROMAN CHOWINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 S MAIN ST
WETUMKA OK
74883-4015
US

IV. Provider business mailing address

143 LIBERTY CIR
MCALESTER OK
74501-1998
US

V. Phone/Fax

Practice location:
  • Phone: 405-452-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6983
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: