Healthcare Provider Details

I. General information

NPI: 1306366570
Provider Name (Legal Business Name): TRACI COWAN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8210 FLOYD CURL DR
SAN ANTONIO TX
78229-3923
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-4700
  • Fax:
Mailing address:
  • Phone: 210-450-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number33049
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: