Healthcare Provider Details

I. General information

NPI: 1609832807
Provider Name (Legal Business Name): MICHAEL J BOWMAN DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19365 7TH AVE NE SUITE 114
POULSBO WA
98370
US

IV. Provider business mailing address

1 BOONE RD
BREMERTON WA
98312-1894
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-7414
  • Fax: 360-779-7732
Mailing address:
  • Phone: 360-475-4237
  • Fax: 360-475-4203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00009289
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401007314
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: