Provider Demographics
NPI:1861492639
Name:NOWELL, MICHAEL S (DDS PC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:NOWELL
Suffix:
Gender:M
Credentials:DDS PC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1609 W MAIN ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1362
Mailing Address - Country:US
Mailing Address - Phone:334-793-9826
Mailing Address - Fax:334-671-2956
Practice Address - Street 1:1609 W MAIN ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1362
Practice Address - Country:US
Practice Address - Phone:334-793-9826
Practice Address - Fax:334-671-2956
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL36131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA666371OtherUNITED CONCORDIA
AL23707OtherBLUE CROSS BLUE SHIELD