Provider Demographics
NPI:1184842825
Name:SOWDERS, SAMUEL CLINTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:CLINTON
Last Name:SOWDERS
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:PO BOX 8870
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8870
Mailing Address - Country:US
Mailing Address - Phone:432-682-4289
Mailing Address - Fax:432-682-6290
Practice Address - Street 1:5807 W WADLEY AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-5055
Practice Address - Country:US
Practice Address - Phone:432-682-4289
Practice Address - Fax:432-682-6290
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX186511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice