Provider Demographics
NPI:1821117474
Name:COWLEY, MARK V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:V
Last Name:COWLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5685 S 1475 E
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-4716
Mailing Address - Country:US
Mailing Address - Phone:801-475-8000
Mailing Address - Fax:801-475-8019
Practice Address - Street 1:5685 S 1475 E
Practice Address - Street 2:SUITE 1A
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4716
Practice Address - Country:US
Practice Address - Phone:801-475-8000
Practice Address - Fax:801-475-8019
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141691-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice