Provider Demographics
NPI:1366534596
Name:BOWMAN, KATHRYN RENE (DMD)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:RENE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8234 SW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219
Mailing Address - Country:US
Mailing Address - Phone:503-332-8460
Mailing Address - Fax:503-977-3002
Practice Address - Street 1:1393 MERIDIAN DR
Practice Address - Street 2:SUITE #1
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-8799
Practice Address - Country:US
Practice Address - Phone:503-981-1360
Practice Address - Fax:503-982-3528
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD81711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice