Healthcare Provider Details

I. General information

NPI: 1528172160
Provider Name (Legal Business Name): JEFFREY W. BOWDEN, D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5218 JAMMES RD SUITE C
JACKSONVILLE FL
32210-7700
US

IV. Provider business mailing address

5218 JAMMES RD SUITE C
JACKSONVILLE FL
32210-7700
US

V. Phone/Fax

Practice location:
  • Phone: 904-777-5878
  • Fax: 904-573-0581
Mailing address:
  • Phone: 904-777-5878
  • Fax: 904-573-0581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN00009989
License Number StateFL

VIII. Authorized Official

Name: DR. JEFFREY WELTY BOWDEN
Title or Position: CEO
Credential: DDS
Phone: 904-777-5878