Provider Demographics
NPI:1568627578
Name:MOWERY, SARAH JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:JEAN
Last Name:MOWERY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:JEAN
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5050 CLEMENS PL
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-7965
Mailing Address - Country:US
Mailing Address - Phone:765-617-3308
Mailing Address - Fax:
Practice Address - Street 1:1717 S CALHOUN ST
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46802-5257
Practice Address - Country:US
Practice Address - Phone:260-458-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011191A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist