Provider Demographics
NPI:1427310093
Name:LI, BOWEN (DDS)
Entity type:Individual
Prefix:DR
First Name:BOWEN
Middle Name:
Last Name:LI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 VISTA DEL SOL DR APT 177
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4519
Mailing Address - Country:US
Mailing Address - Phone:716-860-9415
Mailing Address - Fax:
Practice Address - Street 1:12001 RICHMOND AVE #1
Practice Address - Street 2:APT 626
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:716-860-9415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29153122300000X, 1223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program