=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639737919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BOWEN ZHOU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2019
-----------------------------------------------------
Last Update Date | 09/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 119 S MAIN ST
-----------------------------------------------------
City | LEICESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01524-1403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-892-4882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 E 95TH ST APT 24
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10128-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-361-9154
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DN1858615
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------