Provider Demographics
NPI:1316691660
Name:SOWA, KELLY ALEEN (RDH, PHDHP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ALEEN
Last Name:SOWA
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ALEEN
Other - Last Name:WESLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-981-1721
Mailing Address - Fax:724-981-7025
Practice Address - Street 1:350 SHARON NEW CASTLE RD
Practice Address - Street 2:
Practice Address - City:FARRELL
Practice Address - State:PA
Practice Address - Zip Code:16121-1576
Practice Address - Country:US
Practice Address - Phone:724-981-1721
Practice Address - Fax:724-981-7025
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH073677124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist