Provider Demographics
NPI:1285783605
Name:COWARD, GARETH THOMAS (LD)
Entity type:Individual
Prefix:MR
First Name:GARETH
Middle Name:THOMAS
Last Name:COWARD
Suffix:
Gender:M
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CENTER STREET
Mailing Address - Street 2:SUITE 109 AUBURN DENTURE CENTER CENTER STREET PLAZA
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210
Mailing Address - Country:US
Mailing Address - Phone:207-777-1149
Mailing Address - Fax:207-777-1099
Practice Address - Street 1:120 CENTER STREET
Practice Address - Street 2:SUITE 109 AUBURN DENTURE CENTER CENTER STREET PLAZA
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210
Practice Address - Country:US
Practice Address - Phone:207-777-1149
Practice Address - Fax:207-777-1099
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist