Provider Demographics
NPI:1144087081
Name:SOW, KADIATOU (DMD)
Entity type:Individual
Prefix:DR
First Name:KADIATOU
Middle Name:
Last Name:SOW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W GIRARD AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1892
Mailing Address - Country:US
Mailing Address - Phone:347-283-4828
Mailing Address - Fax:
Practice Address - Street 1:2601 N 27TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-3103
Practice Address - Country:US
Practice Address - Phone:267-639-4296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-05
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0446561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice