Provider Demographics
NPI:1114931524
Name:BOWEN, SCOTT MARTIN (DMD MD MPH)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MARTIN
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DMD MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 COURT ST
Mailing Address - Street 2:MAPLE VIEW ORAL AND MAXILLOFACIAL SURGERY, PC
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753
Mailing Address - Country:US
Mailing Address - Phone:802-388-6344
Mailing Address - Fax:802-388-4103
Practice Address - Street 1:58 COURT ST
Practice Address - Street 2:MAPLE VIEW ORAL AND MAXILLOFACIAL SURGERY, PC
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753
Practice Address - Country:US
Practice Address - Phone:802-388-6344
Practice Address - Fax:802-388-4103
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT01600021721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1010129Medicaid
VT364864OtherMVP
VT59739OtherBCBS
VT59739OtherBCBS
VTBOVN3286Medicare ID - Type Unspecified