Provider Demographics
NPI:1750928222
Name:ROWLEY, NICHOLAS CLARK (DMD)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:CLARK
Last Name:ROWLEY
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 1:111000 S. RIVER HEIGHTS DR. APT #C211
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:435-592-3583
Mailing Address - Fax:
Practice Address - Street 1:5455 W 11000 N STE 202
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8802
Practice Address - Country:US
Practice Address - Phone:801-319-6502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11293081-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice