Provider Demographics
NPI:1689892648
Name:ROWAN, J. M. JR (DDS, MSD, PLLC)
Entity Type:Individual
Prefix:DR
First Name:J. M.
Middle Name:
Last Name:ROWAN
Suffix:JR
Gender:M
Credentials:DDS, MSD, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9421
Mailing Address - Country:US
Mailing Address - Phone:903-561-0801
Mailing Address - Fax:
Practice Address - Street 1:3801 BROOKSIDE DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9421
Practice Address - Country:US
Practice Address - Phone:903-561-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics