Provider Demographics
NPI:1962798579
Name:COWDEN, JASON THOMAS (DMD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:THOMAS
Last Name:COWDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 STREAM STONE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-4385
Mailing Address - Country:US
Mailing Address - Phone:505-850-3863
Mailing Address - Fax:
Practice Address - Street 1:7800 CARR WAY NE
Practice Address - Street 2:SUITE 105
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-0900
Practice Address - Country:US
Practice Address - Phone:505-242-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-22
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10474122300000X
NMDD3656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist