# JAY E. COWAN, D.D.S. PROFESSIONAL SERVICES CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134386386
- **Authorized official:** JAY E. COWAN D.D.S. (OWNER/SURGEON)
- **Authorized official phone:** (317) 536-0748

## Contact information

- **Practice address:** 9602 E WASHINGTON ST, INDIANAPOLIS, IN 46229-4504
- **Practice address phone:** (317) 536-0748
- **Practice address fax:** (317) 536-0721
- **Mailing address:** 9602 E WASHINGTON ST, INDIANAPOLIS, IN 46229-4504
- **Mailing address phone:** (317) 536-0748
- **Mailing address fax:** (317) 536-0721

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 12009344A | IN | Yes |

## Other

- **Enumeration date:** 05/16/2008
- **Last updated:** 12/03/2019