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General NPI Number Information
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NPI Number | 1841534369
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Entity Type | Organization
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Legal Business Name | COWDEN FAMILY DENTAL
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Dates
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Enumeration Date | 11/21/2012
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Last Update Date | 11/21/2012
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Provider Practice Location Address
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Address Line | 7800 CARR WAY NE SUITE 105
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City | RIO RANCHO
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State | NM
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Zip | 87144-0900
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Country | US
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Telephone | 505-242-4999
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Fax | 505-242-3530
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Provider Business Mailing Address
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Address Line | 5300 STREAM STONE AVE NW
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City | ALBUQUERQUE
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State | NM
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Zip | 87114-4385
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Country | US
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Telephone | 505-850-3863
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Fax | 505-242-3530
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON THOMAS COWDEN
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Credential | D.M.D.
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Telephone | 505-850-3863
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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 | DD3656
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License Number State | NM
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