Organization
JAY E. COWAN, D.D.S. PROFESSIONAL SERVICES CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAY E. COWAN D.D.S. (OWNER/SURGEON)
(317) 536-0748
Entity
Organization
Contact information
Practice address
9602 E WASHINGTON ST, INDIANAPOLIS, IN 46229-4504
(317) 536-0748
(317) 536-0721
Mailing address
9602 E WASHINGTON ST, INDIANAPOLIS, IN 46229-4504
(317) 536-0748
(317) 536-0721
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
12009344A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200044690
—
IN
05
—
300032016
—
IN
Enumeration date
05/16/2008
Last updated
12/03/2019
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