Provider Demographics
NPI:1659615334
Name:COWELL, CHRISTINA MICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MICHELLE
Last Name:COWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 S GLEBE RD STE 195
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-5606
Mailing Address - Country:US
Mailing Address - Phone:703-304-3881
Mailing Address - Fax:
Practice Address - Street 1:968 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880
Practice Address - Country:US
Practice Address - Phone:781-245-2299
Practice Address - Fax:781-245-7259
Is Sole Proprietor?:No
Enumeration Date:2012-11-19
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414232122300000X
MADN1856084122300000X
NH03850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist