Provider Demographics
NPI:1386781649
Name:BOWEN, JAMES FORREST (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FORREST
Last Name:BOWEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 E HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-6012
Mailing Address - Country:US
Mailing Address - Phone:850-547-8573
Mailing Address - Fax:
Practice Address - Street 1:1177 E HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-6012
Practice Address - Country:US
Practice Address - Phone:850-547-8573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN130371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071857200Medicaid