Provider Demographics
NPI:1306963178
Name:BOWEN, THOMAS OTIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:OTIS
Last Name:BOWEN
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOW INN DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET
Mailing Address - State:SC
Mailing Address - Zip Code:29685-2904
Mailing Address - Country:US
Mailing Address - Phone:864-878-2097
Mailing Address - Fax:
Practice Address - Street 1:102 LUSK DR
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:SC
Practice Address - Zip Code:29696-2629
Practice Address - Country:US
Practice Address - Phone:864-638-7733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ13584Medicaid