Healthcare Provider Details

I. General information

NPI: 1740621606
Provider Name (Legal Business Name): MICHAEL D BOWEN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

292 E SAGINAW RD
SANFORD MI
48657-9220
US

IV. Provider business mailing address

292 E SAGINAW RD
SANFORD MI
48657-9220
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-7378
  • Fax: 989-687-9449
Mailing address:
  • Phone: 989-687-7378
  • Fax: 989-687-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901012107
License Number StateMI

VIII. Authorized Official

Name: DR. MICHAEL DALE BOWEN
Title or Position: PRESIDENT
Credential: DDS
Phone: 989-687-7378