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General NPI Number Information
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NPI Number | 1659647535
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Entity Type | Organization
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Legal Business Name | BOWES DENTAL CARE
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 03/26/2012
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Provider Practice Location Address
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Address Line | 2375 BOWES DENTAL CARE SUITE #200
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 847-697-9900
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Fax | 847-697-9910
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Provider Business Mailing Address
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Address Line | 2375 BOWES DENTAL CARE SUITE #200
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City | ELGIN
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State | IL
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Zip | 60123
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Country | US
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Telephone | 847-697-9900
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Fax | 847-697-9910
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Authorized Official
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Title or Position | OWNER
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Name | SANTHI YENNA
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Credential | DDS
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Telephone | 847-697-9900
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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 | 019-025163
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License Number State | IL
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