Provider Demographics
NPI:1063701787
Name:COWGILL, CARY P (DDS)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:P
Last Name:COWGILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2127 E VICTORY DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3917
Mailing Address - Country:US
Mailing Address - Phone:912-443-6013
Mailing Address - Fax:912-443-6014
Practice Address - Street 1:2127 E VICTORY DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-3917
Practice Address - Country:US
Practice Address - Phone:912-443-6013
Practice Address - Fax:912-443-6014
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2015-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3376122300000X
GADN0144991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA2745309OtherUNITED CONCORDIA
GA003128901AMedicaid
SCZG4499Medicaid