Provider Demographics
NPI:1437642642
Name:MOWERY, BRENT CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:CHARLES
Last Name:MOWERY
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 1:2927 HAVANA ST UNIT 302
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3565
Mailing Address - Country:US
Mailing Address - Phone:785-760-4679
Mailing Address - Fax:
Practice Address - Street 1:209 W LITTLETON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120
Practice Address - Country:US
Practice Address - Phone:785-760-4679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-12
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00203621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist