MEDICARE: DR. DAVID COWIN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry		CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2037927722	OTHER		TELEPHONE NO

General Provider Information

NPI Number	:	1194755561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID COWIN DMD

Provider Business Mailing Address
First Line	:	52 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5620
Country	:	US
Telephone Number	:	203-792-7722
Fax Number	:	203-744-3725

Provider Business Practice Location Address
First Line	:	52 NORTH ST
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810-5620
Country	:	US
Telephone Number	:	203-792-7722
Fax Number	:	203-744-3725

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/25/2008

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