Provider Demographics
NPI:1134332554
Name:MCKOWN, JAMES T (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:MCKOWN
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 1:938 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-7484
Mailing Address - Country:US
Mailing Address - Phone:937-393-9913
Mailing Address - Fax:937-393-3795
Practice Address - Street 1:938 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-7484
Practice Address - Country:US
Practice Address - Phone:937-393-9913
Practice Address - Fax:937-393-3795
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH146981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268624Medicaid