Provider Demographics
NPI:1427112119
Name:ADVANCED DENTISTRY OF CHARLOTTE
Entity type:Organization
Organization Name:ADVANCED DENTISTRY OF CHARLOTTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF PRACTICE- DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-337-8070
Mailing Address - Street 1:1618 E MOREHEAD STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207
Mailing Address - Country:US
Mailing Address - Phone:704-337-8070
Mailing Address - Fax:704-337-8071
Practice Address - Street 1:1618 E MOREHEAD STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207
Practice Address - Country:US
Practice Address - Phone:704-337-8070
Practice Address - Fax:704-337-8071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6319122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty