Provider Demographics
NPI:1699072827
Name:THOMAS L. BOWERS, IV, D.M.D., M.D., PA
Entity type:Organization
Organization Name:THOMAS L. BOWERS, IV, D.M.D., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:IV
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:352-735-5400
Mailing Address - Street 1:2023 W OLD US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-3626
Mailing Address - Country:US
Mailing Address - Phone:352-735-5400
Mailing Address - Fax:352-735-0911
Practice Address - Street 1:2023 W OLD US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-3626
Practice Address - Country:US
Practice Address - Phone:352-735-5400
Practice Address - Fax:352-735-0911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN99911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH04851Medicare UPIN