Provider Demographics
NPI:1396016333
Name:COWEN, AFTON NORENE (DMD)
Entity type:Individual
Prefix:DR
First Name:AFTON
Middle Name:NORENE
Last Name:COWEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:AFTON
Other - Middle Name:NORENE
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 70365
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36107-0365
Mailing Address - Country:US
Mailing Address - Phone:334-420-5038
Mailing Address - Fax:
Practice Address - Street 1:1845 CHERRY ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-2613
Practice Address - Country:US
Practice Address - Phone:334-420-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5893 C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL136442Medicaid