MEDICARE: JIM BOWDEN 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	1223P0221X	Pediatric Dentistry	14024	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	14024	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	825442	OTHER	TX	UNITED CONCORDIA PROVIDER

General Provider Information

NPI Number	:	1699938266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM BOWDEN D.D.S.

Provider Business Mailing Address
First Line	:	7185 WESTWIND DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1748
Country	:	US
Telephone Number	:	915-585-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	7185 WESTWIND DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-1748
Country	:	US
Telephone Number	:	915-585-6373
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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