Provider Demographics
NPI:1528183464
Name:GOWEY, KIM ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:ALAN
Last Name:GOWEY
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 389
Mailing Address - Street 2:1034 W BROADWAY ST
Mailing Address - City:MEDFORD
Mailing Address - State:WI
Mailing Address - Zip Code:54451
Mailing Address - Country:US
Mailing Address - Phone:715-748-4432
Mailing Address - Fax:
Practice Address - Street 1:1034 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:WI
Practice Address - Zip Code:54451-1310
Practice Address - Country:US
Practice Address - Phone:715-748-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001790015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist