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General NPI Number Information
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NPI Number | 1134386386
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Entity Type | Organization
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Legal Business Name | JAY E. COWAN, D.D.S. PROFESSIONAL SERVICES CORPORATION
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 12/03/2019
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Provider Practice Location Address
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Address Line | 9602 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-4504
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Country | US
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Telephone | 317-536-0748
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Fax | 317-536-0721
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Provider Business Mailing Address
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Address Line | 9602 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-4504
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Country | US
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Telephone | 317-536-0748
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Fax | 317-536-0721
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Authorized Official
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Title or Position | OWNER/SURGEON
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Name | JAY E. COWAN
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Credential | D.D.S.
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Telephone | 317-536-0748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12009344A
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License Number State | IN
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