Provider Demographics
NPI:1154724649
Name:BOWENS, MICHELLE JUANATAS (DDS)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JUANATAS
Last Name:BOWENS
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 1:826 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2235
Mailing Address - Country:US
Mailing Address - Phone:661-725-1797
Mailing Address - Fax:
Practice Address - Street 1:826 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2235
Practice Address - Country:US
Practice Address - Phone:661-725-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2015-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30490122300000X
CA65206122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist