Healthcare Provider Details

I. General information

NPI: 1205034097
Provider Name (Legal Business Name): ALINE Q BOWERS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD # D3-11
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

3946 SAINT JOHNS AVE APT 31
JACKSONVILLE FL
32205-9353
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5950
  • Fax:
Mailing address:
  • Phone: 904-386-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN 17932
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: