Healthcare Provider Details

I. General information

NPI: 1164918884
Provider Name (Legal Business Name): LANCE BOWERS DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
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 TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. LANCE LAWRENCE BOWERS
Title or Position: MANAGER
Credential: DMD
Phone: 360-786-1313