Healthcare Provider Details

I. General information

NPI: 1730812678
Provider Name (Legal Business Name): ALEXANDER BRADLEY BOWDEN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 W PIERSON RD
FLUSHING MI
48433-2339
US

IV. Provider business mailing address

6321 N MCKINLEY RD
FLUSHING MI
48433-2900
US

V. Phone/Fax

Practice location:
  • Phone: 810-733-6677
  • Fax:
Mailing address:
  • Phone: 810-252-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901601441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: