Provider Demographics
NPI:1114030053
Name:SOWARDS, MARK ELWIN (DDS,MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELWIN
Last Name:SOWARDS
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 S 41ST DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-4075
Mailing Address - Country:US
Mailing Address - Phone:928-446-3581
Mailing Address - Fax:
Practice Address - Street 1:1030 W 24TH ST STE C-1
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8319
Practice Address - Country:US
Practice Address - Phone:928-343-9559
Practice Address - Fax:928-343-0084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics