MEDICARE: DR. TOD C BOWMAN DDS

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	1223G0001X	General Practice Dentistry	40337	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	848726	OTHER	CA	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1225188899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOD C BOWMAN DDS

Provider Business Mailing Address
First Line	:	129 MAPLE AVE.
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008
Country	:	US
Telephone Number	:	760-492-5881
Fax Number	:	760-729-5997

Provider Business Practice Location Address
First Line	:	2879 HOPE AVE
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92008-1833
Country	:	US
Telephone Number	:	760-729-5881
Fax Number	:	760-729-5997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	10/20/2015

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