Provider Demographics
NPI:1285768812
Name:CRANIOFACIAL IMAGING
Entity type:Organization
Organization Name:CRANIOFACIAL IMAGING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWLBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-926-1626
Mailing Address - Street 1:6545 FRANCE AVE S STE C61
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2157
Mailing Address - Country:US
Mailing Address - Phone:952-926-1626
Mailing Address - Fax:
Practice Address - Street 1:6545 FRANCE AVE S STE C61
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2157
Practice Address - Country:US
Practice Address - Phone:952-926-1626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial RadiologyGroup - Single Specialty