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General NPI Number Information
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NPI Number | 1053465583
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Entity Type | Organization
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Legal Business Name | MARK M BOWMAN DDS MSD INC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 803 E WASHINGTON ST SUITE 100
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City | MEDINA
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State | OH
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Zip | 44256
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Country | US
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Telephone | 330-722-6884
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Fax | 330-722-0575
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Provider Business Mailing Address
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Address Line | 803 E WASHINGTON ST SUITE 100
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City | MEDINA
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State | OH
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Zip | 44256
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Country | US
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Telephone | 330-722-6884
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Fax | 330-722-0575
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK M BOWMAN
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Credential | DDS MSD
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Telephone | 330-722-6884
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20639
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License Number State | OH
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