Provider Demographics
NPI:1083013866
Name:BOWMAN, CHRISTINA (DDS)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 PRINCIPIO RD
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1520
Mailing Address - Country:US
Mailing Address - Phone:443-206-1382
Mailing Address - Fax:
Practice Address - Street 1:805 PRINCIPIO RD
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1520
Practice Address - Country:US
Practice Address - Phone:443-206-1382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014145971223G0001X
MD172171223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice