Provider Demographics
NPI:1780691154
Name:NOWLIN, ROBERT GORDON (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GORDON
Last Name:NOWLIN
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6400 COBBS DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-2571
Mailing Address - Country:US
Mailing Address - Phone:254-776-6077
Mailing Address - Fax:254-776-2065
Practice Address - Street 1:6400 COBBS DR
Practice Address - Street 2:SUITE 700
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2571
Practice Address - Country:US
Practice Address - Phone:254-776-6077
Practice Address - Fax:254-776-2065
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics