Provider Demographics
NPI:1487733358
Name:DWIGHT K STOWELL JR DMD
Entity type:Organization
Organization Name:DWIGHT K STOWELL JR DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:T
Authorized Official - Last Name:BOUSQUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-249-8545
Mailing Address - Street 1:38 EXCHANGE STREET
Mailing Address - Street 2:
Mailing Address - City:ATHOL
Mailing Address - State:MA
Mailing Address - Zip Code:01331
Mailing Address - Country:US
Mailing Address - Phone:978-249-8545
Mailing Address - Fax:978-249-8528
Practice Address - Street 1:38 EXCHANGE STREET
Practice Address - Street 2:
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331
Practice Address - Country:US
Practice Address - Phone:978-249-8545
Practice Address - Fax:978-249-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty