Provider Demographics
NPI:1659436012
Name:RICHARD S. MOWRY, DMD
Entity Type:Organization
Organization Name:RICHARD S. MOWRY, DMD
Other - Org Name:RANCHO DEL REY ORAL AND FACIAL SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORAL AND MAXILLOFACIAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOWRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:619-421-2322
Mailing Address - Street 1:1040 TIERRA DEL REY
Mailing Address - Street 2:SUITE # 109
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7865
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1040 TIERRA DEL REY
Practice Address - Street 2:SUITE # 109
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7865
Practice Address - Country:US
Practice Address - Phone:619-421-2322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31501261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery