Healthcare Provider Details

I. General information

NPI: 1114453529
Provider Name (Legal Business Name): LANCE BOWERS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 LITTLEROCK RD SW
TUMWATER WA
98512
US

IV. Provider business mailing address

6340 LITTLEROCK RD SW
TUMWATER WA
98512
US

V. Phone/Fax

Practice location:
  • Phone: 360-786-1313
  • Fax: 360-786-1603
Mailing address:
  • Phone: 360-786-1313
  • Fax: 360-786-1603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE60737401
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDE60737401
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: