Provider Demographics
NPI:1265459986
Name:ROWAN, MATTHEW LAWRENCE
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:LAWRENCE
Last Name:ROWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 S PEORIA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3464
Mailing Address - Country:US
Mailing Address - Phone:303-367-2273
Mailing Address - Fax:
Practice Address - Street 1:1050 S PEORIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3464
Practice Address - Country:US
Practice Address - Phone:303-367-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7987122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO14259745Medicaid