Provider Demographics
NPI:1972522944
Name:M COWAN & ASSOCIATES DDS PA
Entity Type:Organization
Organization Name:M COWAN & ASSOCIATES DDS PA
Other - Org Name:DENTAL SPECIALTY CENTER OF PEMBROKE PINES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:COWAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-432-7025
Mailing Address - Street 1:9050 PINES BLVD
Mailing Address - Street 2:SUITE 420
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6455
Mailing Address - Country:US
Mailing Address - Phone:954-432-7025
Mailing Address - Fax:954-432-7613
Practice Address - Street 1:9050 PINES BLVD
Practice Address - Street 2:SUITE 420
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6455
Practice Address - Country:US
Practice Address - Phone:954-432-7025
Practice Address - Fax:954-432-7613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL74321223E0200X
FL94761223E0200X
FL114021223P0300X
FL173731223P0300X
FL97831223S0112X
FL161251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty