Provider Demographics
NPI:1790909018
Name:COWAN, RYAN C (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:COWAN
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1017
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-1017
Mailing Address - Country:US
Mailing Address - Phone:254-582-9555
Mailing Address - Fax:
Practice Address - Street 1:201 OLD BRANDON RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-2326
Practice Address - Country:US
Practice Address - Phone:254-582-9555
Practice Address - Fax:254-582-8477
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX226781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies