MEDICARE: DR. ROBERT DALE BOWMAN JR. DMD

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	8629	NC

General Provider Information

NPI Number	:	1538320205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DALE BOWMAN JR. DMD

Provider Business Mailing Address
First Line	:	5955 WEDDINGTON MONROE RD
Second Line	:	SUITE 101
City	:	WESLEY CHAPEL
State	:	NC
Zip	:	28104-6273
Country	:	US
Telephone Number	:	704-612-1313
Fax Number	:	704-973-0682

Provider Business Practice Location Address
First Line	:	5955 WEDDINGTON MONROE RD
Second Line	:	SUITE 101
City	:	WESLEY CHAPEL
State	:	NC
Zip	:	28104-6273
Country	:	US
Telephone Number	:	704-612-1313
Fax Number	:	704-973-0682

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

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	10/31/2011

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