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General NPI Number Information
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NPI Number | 1962010611
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Entity Type | Organization
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Legal Business Name | BOWLING GREEN PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 03/28/2025
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Provider Practice Location Address
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Address Line | 1687 BRIANNA CT
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5380
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Country | US
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Telephone | 270-316-7555
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Fax | 270-715-0931
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Provider Business Mailing Address
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Address Line | 1687 BRIANNA CT
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City | BOWLING GREEN
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State | KY
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Zip | 42104-5380
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Country | US
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Telephone | 270-316-7555
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Fax | 270-715-0931
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Authorized Official
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Title or Position | OWNER
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Name | DR. MATTHEW DAMIN
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Credential | DMD MSD
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Telephone | 270-316-7555
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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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