Provider Demographics
NPI:1871826131
Name:ROWAN, ROBERT CREED (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CREED
Last Name:ROWAN
Suffix:
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 1:631 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2814
Mailing Address - Country:US
Mailing Address - Phone:209-383-9187
Mailing Address - Fax:209-383-9191
Practice Address - Street 1:631 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2814
Practice Address - Country:US
Practice Address - Phone:209-383-9187
Practice Address - Fax:209-383-9191
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-17
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice