Provider Demographics
NPI:1508023839
Name:COWAN, MELANIE SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:SUE
Last Name:COWAN
Suffix:
Gender:F
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 556
Mailing Address - Street 2:
Mailing Address - City:SHINER
Mailing Address - State:TX
Mailing Address - Zip Code:77984-0556
Mailing Address - Country:US
Mailing Address - Phone:361-594-2800
Mailing Address - Fax:361-594-4109
Practice Address - Street 1:821 N AVE D
Practice Address - Street 2:
Practice Address - City:SHINER
Practice Address - State:TX
Practice Address - Zip Code:77984
Practice Address - Country:US
Practice Address - Phone:361-594-2800
Practice Address - Fax:361-594-4109
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice