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General NPI Number Information
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NPI Number | 1245335124
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Entity Type | Organization
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Legal Business Name | BOWLES ORTHODONTIC SPECIALISTS PA
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 06/12/2008
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Provider Practice Location Address
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Address Line | 309 CONCORD ST # C
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City | KNOXVILLE
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State | TN
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Zip | 37919-3304
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Country | US
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Telephone | 865-546-0792
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Fax | 865-546-0877
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Provider Business Mailing Address
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Address Line | 309 CONCORD ST # C
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City | KNOXVILLE
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State | TN
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Zip | 37919-3304
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Country | US
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Telephone | 865-546-0792
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Fax | 865-546-0877
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD M. BOWLES
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Credential | DDS MS
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Telephone | 865-546-0792
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 1763
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License Number State | TN
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