MEDICARE: DR. MATTHEW SEAN COWMAN D.D.S.

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	1223G0001X	General Practice Dentistry	41006	CA

General Provider Information

NPI Number	:	1972728517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SEAN COWMAN D.D.S.

Provider Business Mailing Address
First Line	:	1300 GRAND AVE
Second Line	:	SUITE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4287
Country	:	US
Telephone Number	:	858-274-9494
Fax Number	:	858-274-3494

Provider Business Practice Location Address
First Line	:	1300 GRAND AVE
Second Line	:	SUITE E
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4287
Country	:	US
Telephone Number	:	858-274-9494
Fax Number	:	858-274-3494

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

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/03/2012

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