MEDICARE: J&L BOWMAN CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1124219613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J&L BOWMAN CORP

Provider Business Mailing Address
First Line	:	888 SOUTH U.S. HWY #1
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2126
Country	:	US
Telephone Number	:	321-631-3155
Fax Number	:	631-638-8684

Provider Business Practice Location Address
First Line	:	888 SOUTH U.S. HWY #1
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-2126
Country	:	US
Telephone Number	:	321-631-3155
Fax Number	:	631-638-8684

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JIMMY ALLEN BOWMAN
Credential	:	DMD
Telephone Number	:	321-631-3155

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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