Provider Demographics
NPI:1881255727
Name:STOWELL, JEFFREY DONALD (DMD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DONALD
Last Name:STOWELL
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 1:721 S JUBILEE DR
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-4835
Mailing Address - Country:US
Mailing Address - Phone:951-553-6401
Mailing Address - Fax:
Practice Address - Street 1:9269 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6572
Practice Address - Country:US
Practice Address - Phone:801-566-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13123748-99221223G0001X
TX35329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Yes1223G0001XDental ProvidersDentistGeneral Practice