Healthcare Provider Details

I. General information

NPI: 1942392519
Provider Name (Legal Business Name): JOE E. BOWERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 MCCOY DRIVE
HARRISON AR
72601-2743
US

IV. Provider business mailing address

1405 MCCOY DRIVE
HARRISON AR
72601-2743
US

V. Phone/Fax

Practice location:
  • Phone: 870-741-5030
  • Fax:
Mailing address:
  • Phone: 870-741-5030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2524
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: