MEDICARE: DR. JACK ARNOLD BOWERS DDS

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	2573	WV

General Provider Information

NPI Number	:	1730368226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK ARNOLD BOWERS DDS

Provider Business Mailing Address
First Line	:	HC 63 BOX 57
Second Line	:
City	:	SUGAR GROVE
State	:	WV
Zip	:	26815-9501
Country	:	US
Telephone Number	:	304-358-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	HC 63 BOX 57
Second Line	:
City	:	SUGAR GROVE
State	:	WV
Zip	:	26815-9501
Country	:	US
Telephone Number	:	304-358-3886
Fax Number	:

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

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	10/31/2007

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