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General NPI Number Information
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NPI Number | 1164960357
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Entity Type | Organization
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Legal Business Name | JAMIL SOWAN, DDS, INC.
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Dates
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Enumeration Date | 02/07/2017
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Last Update Date | 02/07/2017
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Provider Practice Location Address
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Address Line | 10408 PORTSMOUTH RD
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City | MANASSAS
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State | VA
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Zip | 20109-8032
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Country | US
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Telephone | 571-265-7078
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Fax |
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Provider Business Mailing Address
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Address Line | 10408 PORTSMOUTH RD
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City | MANASSAS
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State | VA
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Zip | 20109-8032
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Country | US
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Telephone | 571-265-7078
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JAMIL SOWAN
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Credential | DDS
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Telephone | 571-265-7078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401414592
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License Number State | VA
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