Healthcare Provider Details

I. General information

NPI: 1962546051
Provider Name (Legal Business Name): CHARLES ALAN BOWERS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3567 W. MT. WHITNEY AVE.
RIVERDALE CA
93656
US

IV. Provider business mailing address

PO BOX 543
RIVERDALE CA
93656-0543
US

V. Phone/Fax

Practice location:
  • Phone: 559-867-4416
  • Fax: 559-867-6002
Mailing address:
  • Phone: 559-867-4416
  • Fax: 559-867-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number31211
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: