Provider Demographics
NPI:1093714305
Name:JOWETT, TED A (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:A
Last Name:JOWETT
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 1:1017 SW GAGE BLVD
Mailing Address - Street 2:#C
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1797
Mailing Address - Country:US
Mailing Address - Phone:785-272-3864
Mailing Address - Fax:785-272-3151
Practice Address - Street 1:1017 SW GAGE BLVD
Practice Address - Street 2:#C
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1797
Practice Address - Country:US
Practice Address - Phone:785-272-3864
Practice Address - Fax:785-272-3151
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS59541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice