Provider Demographics
NPI:1215910138
Name:ROWE, GERALD L (DMD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:L
Last Name:ROWE
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 1:1802 SPRING CT
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7346
Mailing Address - Country:US
Mailing Address - Phone:307-635-6300
Mailing Address - Fax:307-635-6361
Practice Address - Street 1:1802 SPRING CT
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7346
Practice Address - Country:US
Practice Address - Phone:307-635-6300
Practice Address - Fax:307-635-6361
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice