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General NPI Number Information
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NPI Number | 1427102615
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Entity Type | Organization
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Legal Business Name | BOWMAN DENTAL GROUP
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 741 W STATE ST STE. 1
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City | O FALLON
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State | IL
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Zip | 62269-1971
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Country | US
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Telephone | 618-632-2282
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Fax |
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Provider Business Mailing Address
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Address Line | 741 W STATE ST STE. 1
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City | O FALLON
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State | IL
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Zip | 62269-1971
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Country | US
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Telephone | 618-632-2282
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TONYA L. BOWMAN
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Credential | D.M.D.
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Telephone | 618-632-2282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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