Healthcare Provider Details

I. General information

NPI: 1720008477
Provider Name (Legal Business Name): DOUGLAS ROBERT BOWMAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 NAPOLEON ST
FREMONT OH
43420-2358
US

IV. Provider business mailing address

15621 SWIFT CURRENT CT
PERRYSBURG OH
43551-7624
US

V. Phone/Fax

Practice location:
  • Phone: 419-332-1303
  • Fax: 419-332-0805
Mailing address:
  • Phone: 419-878-8945
  • 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:
Title or Position:
Credential:
Phone: