MEDICARE: BOWSER FAMILY DENTISTRY LLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1669269577
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWSER FAMILY DENTISTRY LLC

Provider Business Mailing Address
First Line	:	330 BAYSPRING DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46814-9052
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3615 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5539
Country	:	US
Telephone Number	:	260-424-6031
Fax Number	:	260-755-5176

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. KEVIN JAMES BOWSER
Credential	:	DDS
Telephone Number	:	574-215-6544

Provider Enumeration Date	:	04/23/2025
Last Update Date	:	04/23/2025

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Directions to “BOWSER FAMILY DENTISTRY LLC ” Practice Location

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