Provider Demographics
NPI:1427102615
Name:BOWMAN DENTAL GROUP
Entity type:Organization
Organization Name:BOWMAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:618-632-2282
Mailing Address - Street 1:741 W STATE ST
Mailing Address - Street 2:STE. 1
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-1971
Mailing Address - Country:US
Mailing Address - Phone:618-632-2282
Mailing Address - Fax:
Practice Address - Street 1:741 W STATE ST
Practice Address - Street 2:STE. 1
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-1971
Practice Address - Country:US
Practice Address - Phone:618-632-2282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty