Provider Demographics
NPI:1629092002
Name:COWAN, DAVID WOOD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WOOD
Last Name:COWAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 SOUTHLAKE PARK
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3616
Mailing Address - Country:US
Mailing Address - Phone:205-278-3316
Mailing Address - Fax:205-278-3318
Practice Address - Street 1:2000 SOUTHLAKE PARK
Practice Address - Street 2:SUITE 250
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35244-3616
Practice Address - Country:US
Practice Address - Phone:205-278-3316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51091025OtherBLUE CROSS BLUE SHIELD