Provider Demographics
NPI:1700181070
Name:COWGILL, SAMUEL W (DMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:W
Last Name:COWGILL
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 1:685 N LACROSSE ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1492
Mailing Address - Country:US
Mailing Address - Phone:605-721-8919
Mailing Address - Fax:605-394-5217
Practice Address - Street 1:685 N LACROSSE ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1492
Practice Address - Country:US
Practice Address - Phone:605-721-8919
Practice Address - Fax:605-394-5217
Is Sole Proprietor?:No
Enumeration Date:2011-01-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDO960122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDDO960OtherSTATE BOARD OF DENTISTRY LICENSE NUMBER
SDFC2391302OtherDEA