Healthcare Provider Details

I. General information

NPI: 1780614099
Provider Name (Legal Business Name): K. DOUGLAS BOWERS, DDS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 MARY ESTHER BLVD SUITE 401
MARY ESTHER FL
32569-1972
US

IV. Provider business mailing address

151 MARY ESTHER BLVD SUITE 401
MARY ESTHER FL
32569-1972
US

V. Phone/Fax

Practice location:
  • Phone: 850-796-2838
  • Fax: 850-796-3204
Mailing address:
  • Phone: 850-796-2838
  • Fax: 850-796-3204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN9990
License Number StateFL

VIII. Authorized Official

Name: DR. KARL DOUGLAS BOWERS
Title or Position: PRESIDENT
Credential: DDS
Phone: 850-796-2838