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General NPI Number Information
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NPI Number | 1114446564
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Entity Type | Individual
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Provider Name | DOUGLAS YALE BOWEN DMD, MPH
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Gender | Male
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Dates
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Enumeration Date | 09/18/2017
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Last Update Date | 05/01/2023
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Provider Practice Location Address
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Address Line | 809 S. CHUGACH ST. STE. #2
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City | PALMER
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State | AK
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Zip | 99645
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Country | US
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Telephone | 907-745-5337
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Fax | 907-745-5338
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Provider Business Mailing Address
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Address Line | 809 S. CHUGACH ST. STE. #2
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City | PALMER
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State | AK
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Zip | 99645
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Country | US
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Telephone | 907-745-5337
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Fax | 907-745-5338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | LL-455-17
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 149005
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License Number State | AK
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