Provider Demographics
NPI:1154519551
Name:ROWAN, RICHARD DALE (DMD,MSD,ABO)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:DALE
Last Name:ROWAN
Suffix:
Gender:M
Credentials:DMD,MSD,ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2837
Mailing Address - Country:US
Mailing Address - Phone:209-384-3223
Mailing Address - Fax:209-384-2707
Practice Address - Street 1:544 W 26TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2837
Practice Address - Country:US
Practice Address - Phone:209-384-3223
Practice Address - Fax:209-384-2707
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303441223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics