Provider Demographics
NPI:1316089055
Name:MCDOWELL, BRUCE P (DENTIST)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:P
Last Name:MCDOWELL
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E 96TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3782
Mailing Address - Country:US
Mailing Address - Phone:317-846-2882
Mailing Address - Fax:317-846-7650
Practice Address - Street 1:3520 E 96TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-3782
Practice Address - Country:US
Practice Address - Phone:317-846-2882
Practice Address - Fax:317-846-7650
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008112122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist