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General NPI Number Information
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NPI Number | 1629761598
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Entity Type | Individual
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Provider Name | BO WEN ZHANG DMD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2023
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Last Update Date | 05/29/2023
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Provider Practice Location Address
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Address Line | 3310 BLUFF CREEK DR STE 103
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City | COLUMBIA
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State | MO
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Zip | 65201-3582
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Country | US
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Telephone | 573-246-0371
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Fax |
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Provider Business Mailing Address
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Address Line | 16511 WILD HORSE CREEK RD APT 302
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1436
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Country | US
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Telephone | 216-333-7466
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Fax |
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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 | 2023019554
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License Number State | MO
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