MEDICARE: DR. JEREMY LEE BOWEN D.D.S.

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	2007014390	MO

General Provider Information

NPI Number	:	1386845188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEREMY LEE BOWEN D.D.S.

Provider Business Mailing Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE A
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-478-3600
Fax Number	:	816-478-0246

Provider Business Practice Location Address
First Line	:	19201 E VALLEY VIEW PKWY
Second Line	:	SUITE A
City	:	INDEPENDENCE
State	:	MO
Zip	:	64055-6910
Country	:	US
Telephone Number	:	816-478-3600
Fax Number	:	816-478-0246

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	09/30/2010

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