Healthcare Provider Details

I. General information

NPI: 1326208612
Provider Name (Legal Business Name): DOUGLAS R BOWMAN DDS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 NAPOLEON ST
FREMONT OH
43420-2358
US

IV. Provider business mailing address

1229 NAPOLEON ST
FREMONT OH
43420-2358
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-1303
  • Fax: 419-332-0805
Mailing address:
  • Phone: 419-332-1303
  • Fax: 419-332-0805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15560
License Number StateOH

VIII. Authorized Official

Name: DR. DOUGLAS ROBERT BOWMAN
Title or Position: OWNER
Credential: DDS MS
Phone: 419-332-1303