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General NPI Number Information
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NPI Number | 1669269577
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Entity Type | Organization
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Legal Business Name | BOWSER FAMILY DENTISTRY LLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 3615 LAKE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-5539
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Country | US
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Telephone | 260-424-6031
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Fax | 260-755-5176
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Provider Business Mailing Address
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Address Line | 330 BAYSPRING DR
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City | FORT WAYNE
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State | IN
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Zip | 46814-9052
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. KEVIN JAMES BOWSER
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Credential | DDS
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Telephone | 574-215-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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