Healthcare Provider Details

I. General information

NPI: 1083693055
Provider Name (Legal Business Name): DANIEL LEON BOWER DMD MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 N ALAFAYA TRL STE 100
ORLANDO FL
32826-4733
US

IV. Provider business mailing address

819 SHADOWMOSS DR
WINTER GARDEN FL
34787-5257
US

V. Phone/Fax

Practice location:
  • Phone: 407-275-6626
  • Fax: 407-275-9972
Mailing address:
  • Phone: 321-317-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019-024681
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN21082
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: