=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811284136
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOWLING & MAIERS, DDS, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2011
-----------------------------------------------------
Last Update Date | 01/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1412 BLIZZARD DR
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-424-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1412 BLIZZARD DR
-----------------------------------------------------
City | PARKERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-424-6100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. JASON A BOWLING
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 304-424-6100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 2238
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3718
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3862
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 3683
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------