Provider Demographics
NPI:1790347185
Name:ROWELL, EUGENE IRVIN III (DMD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:IRVIN
Last Name:ROWELL
Suffix:III
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 1:2711 WINDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1696
Mailing Address - Country:US
Mailing Address - Phone:229-247-0437
Mailing Address - Fax:229-242-4395
Practice Address - Street 1:2711 WINDEMERE DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1696
Practice Address - Country:US
Practice Address - Phone:229-247-0437
Practice Address - Fax:229-242-4395
Is Sole Proprietor?:No
Enumeration Date:2019-07-05
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA70331223G0001X
GADN1226341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodontics
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty