Healthcare Provider Details

I. General information

NPI: 1952000812
Provider Name (Legal Business Name): NICHOLAS EVAN BOWERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 07/28/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3102 N HIGHWAY 17
MOUNT PLEASANT SC
29466-6925
US

IV. Provider business mailing address

1971 N MAIN ST
SUMMERVILLE SC
29486-7890
US

V. Phone/Fax

Practice location:
  • Phone: 843-970-7292
  • Fax:
Mailing address:
  • Phone: 843-695-9236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10534
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: