Provider Demographics
NPI:1346438728
Name:SOWERS, JERRY WILLIAM JR (DMD PA)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WILLIAM
Last Name:SOWERS
Suffix:JR
Gender:M
Credentials:DMD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 W 20TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-3732
Mailing Address - Country:US
Mailing Address - Phone:828-464-6464
Mailing Address - Fax:828-464-6406
Practice Address - Street 1:430 W 20TH ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3732
Practice Address - Country:US
Practice Address - Phone:828-464-6464
Practice Address - Fax:828-464-6406
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
NC7179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist