Provider Demographics
NPI:1194818039
Name:COWAN, JAY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:E
Last Name:COWAN
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 1:9602 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-4504
Mailing Address - Country:US
Mailing Address - Phone:317-536-0748
Mailing Address - Fax:317-536-0761
Practice Address - Street 1:9602 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-4504
Practice Address - Country:US
Practice Address - Phone:317-536-0748
Practice Address - Fax:317-536-0761
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120093441223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU64472Medicare UPIN