Provider Demographics
NPI:1851485635
Name:MOWREY DENTAL CORPORATION
Entity Type:Organization
Organization Name:MOWREY DENTAL CORPORATION
Other - Org Name:LA QUINTA DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOWREY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-771-0300
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:78595 HIGHWAY 111
Practice Address - Street 2:STE. 300
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2084
Practice Address - Country:US
Practice Address - Phone:760-771-0300
Practice Address - Fax:760-771-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty