Provider Demographics
NPI:1063472876
Name:SOWELL, JOHN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:SOWELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LINER DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2310
Mailing Address - Country:US
Mailing Address - Phone:864-229-5733
Mailing Address - Fax:864-229-0670
Practice Address - Street 1:112 LINER DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2310
Practice Address - Country:US
Practice Address - Phone:864-229-5733
Practice Address - Fax:864-229-0670
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ21398Medicaid
SCZ21398Medicaid
SCT248810281Medicare ID - Type UnspecifiedORAL SURGEON