MEDICARE: DR. LEE MIDDLE BOWMAN II DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	19667	OH

General Provider Information

NPI Number	:	1245456466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE MIDDLE BOWMAN II DDS

Provider Business Mailing Address
First Line	:	4440 DAWNRIDGE CIR NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-1400
Country	:	US
Telephone Number	:	330-224-0108
Fax Number	:

Provider Business Practice Location Address
First Line	:	8340 CLEVELAND AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-4820
Country	:	US
Telephone Number	:	330-305-9960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	07/08/2007

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