Healthcare Provider Details

I. General information

NPI: 1952506404
Provider Name (Legal Business Name): THOMAS NATHAN BOWLES D.M.D, M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 10/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 LONE OAK RD.
PADUCAH KY
42003
US

IV. Provider business mailing address

2850 LONE OAK RD
PADUCAH KY
42003-8043
US

V. Phone/Fax

Practice location:
  • Phone: 270-554-2026
  • Fax: 270-554-9164
Mailing address:
  • Phone: 270-554-2026
  • Fax: 270-554-9164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8499
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number8499
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: