Provider Demographics
NPI:1538507348
Name:MOWER, STEPHANIE J (DMD)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:J
Last Name:MOWER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:J
Other - Last Name:POULSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18275 N 59TH AVE
Mailing Address - Street 2:BLDG D-120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-1260
Mailing Address - Country:US
Mailing Address - Phone:602-943-7204
Mailing Address - Fax:602-943-1534
Practice Address - Street 1:18275 N 59TH AVE
Practice Address - Street 2:BLDG D-120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-1260
Practice Address - Country:US
Practice Address - Phone:602-943-7204
Practice Address - Fax:602-943-1534
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD8733122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist