| Jay E. Cowan, D.d.s. Professional Services Corporation | |
|
9602 E Washington St Indianapolis IN 46229-4504 | |
| (317) 536-0748 | |
| (317) 536-0721 |
| Full Name | Jay E. Cowan, D.d.s. Professional Services Corporation |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 9602 E Washington St, Indianapolis, Indiana |
| Authorized Official Name and Position | Jay E. Cowan (OWNER/SURGEON) |
| Authorized Official Contact | 3175360748 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jay E. Cowan, D.d.s. Professional Services Corporation 9602 E Washington St Indianapolis IN 46229-4504 Ph: (317) 536-0748 | Jay E. Cowan, D.d.s. Professional Services Corporation 9602 E Washington St Indianapolis IN 46229-4504 Ph: (317) 536-0748 |
| NPI Number | 1134386386 |
|---|---|
| Provider Enumeration Date | 05/16/2008 |
| Last Update Date | 12/03/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134386386 | NPI | - | NPPES |
| 200044690 | Medicaid | IN | |
| 300032016 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 12009344A (Indiana) | Primary |
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