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General NPI Number Information
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NPI Number | 1134510431
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Entity Type | Organization
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Legal Business Name | KEITH W. COWHEY, DDS, INC
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 02/09/2015
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Provider Practice Location Address
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Address Line | 400 5TH ST
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City | SEAL BEACH
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State | CA
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Zip | 90740-5967
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Country | US
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Telephone | 562-431-2929
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Fax |
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Provider Business Mailing Address
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Address Line | 400 5TH ST
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City | SEAL BEACH
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State | CA
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Zip | 90740-5967
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KEITH COWHEY
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Credential | D.D.S.
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Telephone | 562-431-2929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 58482
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License Number State | CA
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