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General NPI Number Information
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NPI Number | 1194924126
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Entity Type | Individual
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Provider Name | BENJAMIN REID BOWLING DDS
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Gender | Male
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 07/11/2007
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Provider Practice Location Address
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Address Line | 911 MARYLAND AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55106-2647
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Country | US
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Telephone | 651-436-5177
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Fax | 651-776-4840
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Provider Business Mailing Address
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Address Line | 6601 LYNDALE AVE S 220
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City | RICHFIELD
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State | MN
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Zip | 55423-2477
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Country | US
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Telephone | 612-861-9141
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Fax | 612-861-9101
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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 | 12455
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License Number State | MN
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