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NPI Code Detail

MEDICARE: JARED BOWEN DMD

MEDICARE: JARED BOWEN DMD
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
11223G0001XGeneral Practice Dentistry30.026737OH

General Provider Information

NPI Number : 1518615624
Entity Type Code : Individual
Provider Name (Legal Business Name) : JARED BOWEN DMD
Provider Business Mailing Address
First Line : 13 WASSER BRIDGE RD
Second Line :
City : GREENVILLE
State : PA
Zip : 16125-9783
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 500 WAKEFIELD DR
Second Line :
City : CORTLAND
State : OH
Zip : 44410-1504
Country : US
Telephone Number : 330-638-3065
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2022
Last Update Date : 03/17/2022

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