MEDICARE: DR. BRENT BOWLING 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	122300000X	Dentist	26039	CA

General Provider Information

NPI Number	:	1609081611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT BOWLING D.D.S.

Provider Business Mailing Address
First Line	:	24400 MUIRLANDS BLVD
Second Line	:	SUITE A
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-3946
Country	:	US
Telephone Number	:	949-581-8760
Fax Number	:	949-581-9661

Provider Business Practice Location Address
First Line	:	24400 MUIRLANDS BLVD
Second Line	:	SUITE A
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-3946
Country	:	US
Telephone Number	:	949-581-8760
Fax Number	:	949-581-9661

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

Provider Enumeration Date	:	05/12/2007
Last Update Date	:	07/08/2007

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