MEDICARE: JEFFREY W. BOWDEN, D.D.S., P.A.

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	1223E0200X	Endodontics	DN00009989	FL

General Provider Information

NPI Number	:	1528172160
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY W. BOWDEN, D.D.S., P.A.

Provider Business Mailing Address
First Line	:	5218 JAMMES RD
Second Line	:	SUITE C
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7700
Country	:	US
Telephone Number	:	904-777-5878
Fax Number	:	904-573-0581

Provider Business Practice Location Address
First Line	:	5218 JAMMES RD
Second Line	:	SUITE C
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-7700
Country	:	US
Telephone Number	:	904-777-5878
Fax Number	:	904-573-0581

Authorized Official
Title or Position	:	CEO
Name	:	DR. JEFFREY WELTY BOWDEN
Credential	:	DDS
Telephone Number	:	904-777-5878

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	08/22/2020

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